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.
 

Otezla SupportPlus Program

This program provides brand name medications at no or low cost

Provided by: Amgen, Inc.


TEL: 844-468-3952


ALT PHONE: 855-554-9168
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Otezla SupportPlus Patient Assistance Application

Otezla SupportPlus Patient Assistance Application (Spanish)

Otezla SupportPlus Start Form for Healthcare Professionals

 

Medications

  • apremilast tablet (Otezla) Tablet
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income Determined case by case
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be US citizen or permanent resident
   

Application

Obtaining Call or download
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Varies
Refill Process Pharmacy contacts patient
Limit Varies
Re-application New application yearly
   

Additional Information

*Must provide financial documentation.

This program also provides co-pay, reimbursement assistance and adherence support.
Otezla SupportPlus Program: 844-468-3952
Patient Assistance Program for Otezla: 855-554-9168

Updated September 18, 2020


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

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

  • apremilast tablet (Otezla) Tablet
 

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 Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent 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 September 01, 2020