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

OneSource Patient Support Program from Alexion

This program provides brand name medications at no or low cost

Provided by: Alexion Pharmaceuticals, Inc.

100 College St
New Haven, CT 06510

TEL: 888-765-4747


FAX: 800-420-5150
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

OneSource Enrollment and Authorization Form

OneSource Enrollment and Authorization Form (Spanish)

 

Medications

  • asfotase alfa injection; subcutaneous (Strensiq) Injection; Subcutaneous
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Determined case by case
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be treated by US licensed healthcare provider
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Email or fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section and sign
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Insurance benefits, claims assistance, or other reimbursement help is offered.

Health care providers must enroll in the REMS program prior to submitting the Patient Assistance Program Application

This program also provides copay assistance.

Updated August 04, 2020