Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
Scroll down to see them all.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

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

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Not applicable
Doctor's Action Varies
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient is sent savings card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated August 05, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Circle of Care Patient Assistance Program

For Healthcare Professionals Only

Provided by: Organogenesis Inc.


TEL:


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 reside in the US
   

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 required documents
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 Contact the program for details
Re-application Contact program for details.
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

Contact program for more details: www.Apligraf.com or www.Dermagraft.com

Updated July 14, 2022