Programas de asistencia al paciente para Daurismo

Solicite apoyo para su receta con Daurismo

Si califica, los programas a continuación le pueden ser útiles para conseguir Daurismo. 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 4 — 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
  • Daurismo (glasdegib)
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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Pfizer Savings Program

(Programa 2 de 4 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Pfizer, Inc.
PO Box 66585 St. Louis, MO 63166-6585
TEL: 866-706-2400
FAX: 866-470-1748
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Daurismo (glasdegib)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? No
  • Income Varies
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? Must be residing in the US or US territory
Solicitud
  • Obtaining Call for prescreening
  • Receiving There is no application
  • Returning The completed application's destination is not applicable
  • Doctor's Action Give prescription to patient
  • Applicant's Action Call to enroll
  • Decision Communicated Decision made during phone screening
  • Decision Timeframe Decision made during phone screening
Medicamento
  • Amount/Supply Contact the program for more details.
  • Sent To Pharmacy
  • Delivery Time Not applicable
  • Refill Proces Varies per medication
  • Limit None
  • Re-application New enrollment every 12 months
Información Adicional
This program provides uninsured patients with savings on their prescriptions at the pharmacy. Pfizer also has programs that provide eligible patients with insurance support, copay assistance, and medicines for free. Contact Pfizer RxPathways for details (844-989-7284)
Actualizado July 9, 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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Pfizer Oncology Together

(Programa 3 de 4 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Pfizer, Inc.
PO Box 220366 Charlotte, NC 28222-0366
TEL: 877-744-5675
FAX: 877-736-6506
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Daurismo (glasdegib)
Requisitos de Elegibilidad
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • Diagnosis/Medical Criteria Varies
  • U.S. Residency Required? The patient must also be under treatment from a US doctor.
Solicitud
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning Fax, mail or via Online Portal
  • Doctor's Action Varies
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Not specified
  • Decision Timeframe Varies
Medicamento
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Varies
  • Refill Proces Not specified
  • Limit Varies
  • Re-application Not specified
Información Adicional
Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.
Actualizado July 9, 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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HealthWell Foundation Copay Program

(Programa 4 de 4 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: HealthWell Foundation
P.O. Box 489 Buckeystown, MD 21717
TEL: 800-675-8416
FAX: 800-282-7692
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Daurismo (glasdegib)
Requisitos de Elegibilidad
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
  • U.S. Residency Required? The patient must also be residing in the US.
Solicitud
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be 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 notified in writing
  • Decision Timeframe 3-5 business days
Medicamento
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Información Adicional
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Actualizado July 2, 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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