| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Tavneos ConnectThis program provides brand name medications at no or low cost |
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Provided by: ChemoCentryx, Inc. |
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TEL: 833-828-6367FAX: 833-200-7366 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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Tavneos Connect Start Form |
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Tavneos Connect Overview Brochure |
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| Co-payment assistance, patient support, and patient assistance programs are available for eligible patients. |
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| Updated May 22, 2023 | |||
