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

Viatris Patient Assistance Program (Group One Medicines)

This program provides brand name medications at no or low cost

Provided by: Viatris Inc.


TEL: 888-417-5780


FAX: 877-427-7290
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Viatris Patient Assistance Program (Group One Medicines) Application

Viatris Patient Assistance Program (Group One Medicines) Application (Clozapine)

 

Medications

  • azelastine/fluticasone propionate (Dymista) 
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Not specified
Income Determined case by case
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Email or fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Varies
Delivery Time Varies
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Eligibility determined on a case-by-case basis.
Contact program for details.

Updated November 16, 2022