| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Novartis Patient Assistance Foundation, Inc.This program provides brand name medications at no or low cost |
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Provided by: Novartis Pharmaceuticals |
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PO Box 52029 TEL: 800-277-2254FAX: 855-817-2711 |
Languages Spoken:
English Spanish Others By Translation Service |
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Program Applications and Forms |
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Novartis Patient Assistance Foundation, Inc. Enrollment Application |
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Novartis Patient Assistance Foundation, Inc. Enrollment Application (Spanish) |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no prescription coverage | ||
| Those with Part D Eligible? | Contact program for details. | ||
| Income | Not disclosed | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Yes | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed | ||
| Returning | Fax or mail | ||
| Doctor's Action | Complete section, sign, attach prescription for 90 days | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Doctor notified via mailed letter | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | Varies | ||
| Sent To | Doctor's office or patient is sent card to be used at pharmacy | ||
| Delivery Time | Not specified | ||
| Refill Process | Refill/reorder form included with shipment | ||
| Limit | Not specified | ||
| Re-application | New application, new documentation yearly | ||
Additional Information |
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| For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician. *Additional products may be available. Please contact the program for a complete product listing. www.pap.novartis.com |
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| Updated August 08, 2018 | |||
