| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Mirum Access Plus (MAP)This program provides brand name medications at no or low cost |
|||
Provided by: Mirum Pharmaceuticals, Inc. |
|||
PO Box 4487 TEL: 855-676-4968FAX: 855-282-4884 |
Languages Spoken:
English, Others By Translation Service |
||
Program Applications and Forms |
|||
Mirum Access Plus (MAP) Patient Enrollment Form |
|||
Mirum Access Plus (MAP) Consent Form |
|||
Mirum Access Plus (MAP) Consent Form (Spanish) |
|||
Medications |
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Must be uninsured | ||
| Those with Part D Eligible? | No | ||
| Income | Based on FPL | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must reside in the US | ||
Application |
|||
| Obtaining | Call, download or apply online | ||
| Receiving | Downloaded from website | ||
| Returning | 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 | Varies | ||
| Sent To | Patient's home, unless otherwise noted | ||
| Delivery Time | Shipped overnight | ||
| Refill Process | Company contacts patient to arrange | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
|||
| Co-payment assistance, reimbursement support, patient support, and patient assistance programs are available for eligible patients. |
|||
| Updated April 24, 2023 | |||
