| 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 |
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Provided by: Viatris Inc. |
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TEL: 888-417-5780FAX: 877-427-7290 |
Languages Spoken:
English |
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Program Applications and Forms |
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Viatris Patient Assistance Program (Group One Medicines) Application
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Viatris Patient Assistance Program (Group One Medicines) Application: Clozapine
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Medications |
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Eligibility Requirements |
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| Insurance Status | Uninsured or Underinsured with no prescription coverage for needed medication | ||
| 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 |
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| 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 |
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| Amount/Supply | As prescribed by Doctor | ||
| Sent To | Doctor's office | ||
| Delivery Time | Varies | ||
| Refill Process | Contact program for details. | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
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| Eligibility determined on a case-by-case basis. Contact program for details. |
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| Updated December 06, 2023 | |||
