Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Circle of Care Patient Assistance Program

For Healthcare Professionals Only

Provided by: Organogenesis Inc.


TEL: 888-432-5232


FAX: 866-212-2888 		Languages Spoken:

English

Program Website

 

Program Applications and Forms

Circle of Care Patient Assistance Program Application
 

Medications
  • antimicrobial matrix-wound wound dressing; antimicrobial (PuraPly AM) Wound Dressing; Antimicrobial
 

Eligibility Requirements   
Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be a US resident
   

Application
Obtaining Doctor/Doctor's office must call
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Doctor notified
Decision Timeframe Within 2-3 days
   

Medication
Amount/Supply Not specified
Sent To Doctor's office
Delivery Time Within 2 business days
Refill Process Contact company, determined on case by case basis
Limit Not specified
Re-application Not specified
   

Additional Information
Resources for HEALTHCARE PROFESSIONALS ONLY.

Contact program for more details: www.Apligraf.com or www.Dermagraft.com
Updated October 08, 2021