| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 2. Scroll down to see them all. |
|||
Chiesi CAREDIRECT (Bronchitol)This program provides brand name medications at no or low cost |
|||
Provided by: Chiesi |
|||
TEL: 888-865-1222FAX: 866-410-6241 |
Languages Spoken:
English, Others By Translation Service |
||
Program Applications and Forms |
|||
Chiesi CAREDIRECT Service Request & Prescription Form (Bronchitol) |
|||
Chiesi CAREDIRECT Patient Assistance Application (Bronchitol) |
|||
Medications |
|||
|
|||
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 ProgramThis is a copay assistance program |
|||
Provided by: HealthWell Foundation |
|||
TEL: 800-675-8416 |
Languages Spoken:
English, Others By Translation Service |
||
Program Applications and Forms |
|||
HealthWell Foundation Copay Program Enrollment: Contact program |
|||
HealthWell Foundation COVID-19 Ancillary Costs: Contact program |
|||
Medications |
|||
|
|||
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 | |||
| 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 | |||
