Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Chiesi CAREDIRECT (Bronchitol)

This program provides brand name medications at no or low cost

Provided by: Chiesi


TEL: 888-865-1222


FAX: 866-410-6241
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Chiesi CAREDIRECT Service Request & Prescription Form (Bronchitol)

Chiesi CAREDIRECT Patient Assistance Application (Bronchitol)

 

Medications

  • mannitol powder; inhalation (Bronchitol) Powder; Inhalation
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Must provide diagnosis code
US Residency Required? Must be US citizen or legal entrant
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Email, fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Varies
Delivery Time Varies
Refill Process Automatically sent out
Limit One year
Re-application New application every 12 months
   

Additional Information

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

Updated April 28, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation


TEL: 800-675-8416


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program

HealthWell Foundation COVID-19 Ancillary Costs: Contact program

 

Medications

  • mannitol powder; inhalation (Bronchitol) Powder; Inhalation
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside in the US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months
   

Additional Information

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.

Updated May 09, 2022