Programas de asistencia al paciente para Alunbrig

Solicite apoyo para su receta con Alunbrig

Si califica, los programas a continuación le pueden ser útiles para conseguir Alunbrig. Revise la información para saber si califica. Las solicitudes están disponibles en formato PDF y deben enviarse directamente a quien proporciona el programa de asistencia al paciente.

Si tiene alguna pregunta favor de comunicarse al teléfono para el programa correspondiente (no PharmacyChecker.com), o vaya a la página del programa.

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Alunbrig 1Point

(Programa 1 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Takeda Oncology
PO Box 4280 Gaithersburg, MD 20885-4280
TEL: 844-217-6468
FAX: 844-269-3038
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • Alunbrig (brigatinib)
Requisitos de Elegibilidad
  • Insurance Status *Contact program for details.
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? US residency requirements are not specified.
Solicitud
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning *See Additional Information section below
  • 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 2 business days, once application process is complete
Medicamento
  • Amount/Supply Up to 1 month supply
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Company contacts patient or doctor to arrange
  • Limit One year
  • Re-application Maximum is one year
Información Adicional
*The physician must submit the ALUNBRIG 1Point Enrollment Form before applying for the Patient Assistance Program. This program also provides copay assistance.
Actualizado December 14, 2018

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Good Days Program

(Programa 2 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Good Days from CDF
Attn: Enrollment 6900 Dallas Parkway Suite #200 Plano, TX 75024
TEL: 877-968-7233
FAX: 214-570-3621
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • Alunbrig (brigatinib)
Requisitos de Elegibilidad
  • Insurance Status Not specified
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? US residency requirements are not specified.
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed, mailed or submitted online.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and/or Doctor are notified
  • Decision Timeframe Varies
Medicamento
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Must re-enroll at end of calendar year
Información Adicional
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Actualizado October 5, 2018

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Patient Access Network Foundation (PAN)

(Programa 3 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Alunbrig (brigatinib)
Requisitos de Elegibilidad
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Solicitud
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medicamento
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Información Adicional
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Actualizado July 10, 2018

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