| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||||||
Mavyret Patient Support |
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Provided by: AbbVie |
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AbbVie Customer Service, Department TEL: 877-628-9738ALT PHONE: 855-687-7503 FAX: 866-938-6696 |
Languages Spoken:
English |
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Patient Assistance Applications |
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Mavyret Patient Support Enrollment Form |
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Brand Name Medications Covered |
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Generic Name |
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Eligibility Requirements |
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| Insurance Status | Contact program for details. | ||||||
| Those with Part D Eligible? | Contact program for details. | ||||||
| Income | Not disclosed | ||||||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||||||
| US Residency Required? | Must be treated by US licensed healthcare provider | ||||||
Application |
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| Obtaining | Call or download | ||||||
| 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 |
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| Amount/Supply | Not specified | ||||||
| Sent To | Not specified | ||||||
| Delivery Time | Not specified | ||||||
| Refill Process | Not specified | ||||||
| Limit | Not specified | ||||||
| Re-application | Not specified | ||||||
Additional Information |
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| Updated July 17, 2018 | |||||||
