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

This program provides brand name medications at no or low cost

Provided by: Gilead Sciences, Inc.


TEL: 877-290-6014


ALT PHONE: 877-722-9786
FAX: 877-550-1705
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

Cayston Patient Assistance Program Patient Enrollment Form

 

Brand Name Medications Covered

 
  • Altera Nebulizer for Cayston nebulizer system
  • Cayston
 

Generic Name

 
  • altera nebulizer for cayston nebulizer system
  • aztreonam
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Contact program for details.
Income Based on FPL
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be a US resident
   

Application

Obtaining Call or download from Programs website
Receiving Faxed or mailed
Returning 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 notified in writing
Decision Timeframe 2-3 business days
   

Medication

Amount/Supply Up to 1 month supply
Sent To Patient's home, unless otherwise noted
Delivery Time Within 2 business days
Refill Process Patient contacts pharmacy
Limit Not specified
Re-application Not specified
   

Additional Information

This program also provides copay assistance.


Updated October 17, 2018