Programas de asistencia al paciente para Copiktra

Solicite apoyo para su receta con Copiktra

Si califica, los programas a continuación le pueden ser útiles para conseguir Copiktra. 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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Patient Access Network Foundation (PAN)

(Programa 1 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
  • Copiktra (duvelisib)
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 FDA Approved Diagnosis - See Program Website for Details
  • 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 August 6, 2019

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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Verastem Cares

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

Provienen de: Verastem
P.O. Box 5490 Louisville, KY 40255
TEL: 833-570-2273
FAX: 833-264-8372
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Copiktra (duvelisib)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Yes
  • Income Household income at or less than $150,000
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? Must be a legal resident of the United States or its territories
Solicitud
  • Obtaining Doctor/Doctor's office must call or download
  • Receiving Downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Enroll in program, complete form and obtain patient consent
  • Applicant's Action Complete section and sign
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe 2-3 business days
Medicamento
  • Amount/Supply As prescribed by Doctor
  • Sent To Patient's home
  • Delivery Time Contact Program for Details
  • Refill Proces Contact program for details.
  • Limit Contact the program for details
  • Re-application New application yearly
Información Adicional
This program also provides copay assistance.
Actualizado July 29, 2019

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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