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.
 

Tavneos Connect

This program provides brand name medications at no or low cost

Provided by: ChemoCentryx, Inc.


TEL: 833-828-6367


FAX: 833-200-7366
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Tavneos Connect Start Form

Tavneos Connect Overview Brochure

 

Medications

  • avacopan capsule (Tavneos) Capsule
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Not specified
Income Based on FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US and be under the direct care of a US physician
   

Application

Obtaining Call or download
Receiving Complete online, download from website or faxed.
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified
Decision Timeframe Varies
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Not specified
Limit Varies
Re-application New application yearly
   

Additional Information

Co-payment assistance, patient support, and patient assistance programs are available for eligible patients.

Updated December 06, 2022


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

  • avacopan capsule (Tavneos) Capsule
 

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 December 05, 2022