Programas de asistencia al paciente para Complera

Solicite apoyo para su receta con Complera

Si califica, los programas a continuación le pueden ser útiles para conseguir Complera. 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.

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Advancing Access Program

(Programa 1 de 2 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Gilead Sciences, Inc.
PO Box 13185 La Jolla, CA 92039-3185
TEL: 800-226-2056
FAX: 800-216-6857
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Contact program for details.
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe 3-5 business days
Medicamento
  • Amount/Supply Varies. *see below for details
  • Sent To Varies. *see below for details
  • Delivery Time 1-2 business days
  • Refill Proces Patient contacts pharmacy
  • Limit One calendar year
  • Re-application Once a year new application required. Financial documentation may be requested any time
Información Adicional
Insurance benefits, claims assistance and/or other reimbursement help is offered. If the application is for Vistide, then prescription must be included because it will be sent to the doctor's office. The other medications are given using a pharmacy card. This program is for outpatient use only. This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs. IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company. This program also provides copay assistance.
Actualizado October 11, 2018

Si usted, su paciente o un ser querido no es elegible para este programa o otros, se pueden encontrar precios de aquí.

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Patient Access Network Foundation (PAN)

(Programa 2 de 2 — 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
  • Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)
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

Si usted, su paciente o un ser querido no es elegible para este programa o otros, se pueden encontrar precios de aquí.

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