|Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.
Patient Access Network Foundation (PAN)This is a copay assistance program @if>
Provided by: Patient Access Network Foundation
English, Spanish, Others By Translation Service
Program Applications and Forms
|*See Additional Information section below
|Those with Part D Eligible?
|Determined case by case
|Between 400-500% of FPL
|FDA Approved Diagnosis - See Program Website for Details
|US Residency Required?
|Must reside and receive treatment in US
|Call or complete online
|Complete online or by phone
|Call for information or inform doctor that he/she is in need
|Patient and Doctor are notified
|Within 48 hours
|Patient is sent savings card to be used at pharmacy
|Once approved; shipped same day
|Patient presents voucher/card to pharmacy for each refill
|New application every 12 months
|*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 February 21, 2024