Programas de asistencia al paciente para Edurant

Solicite apoyo para su receta con Edurant

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

(Programa 1 de 5 — 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
  • Edurant tablet (rilpivirine tablet)
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 November 22, 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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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program

(Programa 2 de 5 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Johnson & Johnson Patient Assistance Foundation, Inc.
PO Box 42796 Cincinnati, OH 45242
TEL: 800-652-6227
FAX: 888-526-5168
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Edurant tablet (rilpivirine tablet)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? *See Additional Information Section Below
  • Income Varies. **See below for details
  • Diagnosis/Medical Criteria Medication must be for outpatient use only
  • U.S. Residency Required? The patient must also be permanently residing in the US or US territories.
Solicitud
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • 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 Not specified
  • Sent To Doctor's office or patient is sent card to be used at pharmacy
  • Delivery Time Varies
  • Refill Proces Varies per medication
  • Limit Varies
  • Re-application New application, new documentation yearly
Información Adicional
*Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Please Contact the program for more information (1-800-652-6227). **Please call 1-800-652-6227 or visit Program website for specific FPL income requirements.
Actualizado November 19, 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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Johnson & Johnson Patient Assistance Foundation, Inc. Hospital Access Patient Assistance Program

(Programa 3 de 5 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Johnson & Johnson Patient Assistance Foundation, Inc.
PO Box 42796 Cincinnati, OH 45242
TEL: 800-652-6227
FAX: 800-521-2437
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • Edurant tablet (rilpivirine tablet)
Requisitos de Elegibilidad
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Not specified
  • Income Not applicable
  • Diagnosis/Medical Criteria Not applicable
  • U.S. Residency Required? Must be residing in the US or US territory
Solicitud
  • Obtaining Enroll online
  • Receiving Must apply online
  • Returning Must apply online
  • Doctor's Action Hospital must complete product request form for each replacement
  • Applicant's Action Not specified
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medicamento
  • Amount/Supply Not specified
  • Sent To Hospital
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application, new documentation yearly
Información Adicional
This program allows eligible hospitals to receive free medications to give to qualified outpatients directly. Contact the program for more details (1-800-652-6227). The hospital access application is only available via the online portal.
Actualizado November 19, 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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Good Days Program

(Programa 4 de 5 — 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
  • Edurant tablet (rilpivirine tablet)
Requisitos de Elegibilidad
  • Insurance Status Must have insurance
  • Those with Part D Elibible? Not specified
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must also be a US resident with a Social Security Number.
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 28, 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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HarborPath ADAP Waiting List Program

(Programa 5 de 5 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: HarborPath, Inc.
None
TEL: 855-300-8916
FAX: 888-237-9831
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • Edurant tablet (rilpivirine tablet)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? No
  • Income Determined case by case
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be a US resident.
Solicitud
  • Obtaining Call or download
  • Receiving Faxed or 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 Inform Doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Within 24-48 hours
Medicamento
  • Amount/Supply Varies
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Within 48 hours
  • Refill Proces Doctor/Doctor's office must contact the Program
  • Limit Varies
  • Re-application New prescription required
Información Adicional
Resources for HEALTHCARE PROFESSIONALS ONLY. Patients are eligible for the HarborPath ADAP Waiting List Program if they: Meet eligibility for the ADAP Waiting List Program in their state of residency; and have a confirmation letter from their state ADAP indicating patient is on the ADAP waiting list. Typical eligibility requirements do not apply to the ADAP Waiting List Program.
Actualizado October 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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