Programas de asistencia al paciente para Pentacel

Solicite apoyo para su receta con Pentacel

Si califica, los programas a continuación le pueden ser útiles para conseguir Pentacel. 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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Sanofi Patient Connection Program

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

Provienen de: Sanofi-Aventis U.S. LLC
PO Box 222138 Charlotte, NC 28222-2138
TEL: 888-847-4877
FAX: 888-847-1797
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Pentacel (diptheria and tetanus toxoids and acellular pertussis adsorbed inactivated poliovirus and haemophilus B conjugate tetanus toxoid conjugate vaccine)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
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 are notified
  • Decision Timeframe 2-4 business days
Medicamento
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 2-4 business days
  • Refill Proces Reorder form needs to be submitted
  • Limit None
  • Re-application New application, new documentation yearly
Información Adicional
Negative decision may be appealed. Insurance benefits, claims assistance and/or other reimbursement help is offered. Exceptions to guidelines considered. Patients who do not file taxes must either request a 4506-T form from the IRS, submit proof of benefits received (such as Social Security) Earning Statement, or submit W2's of the person who is supporting them financially. Healthcare provider must contact the Program for REORDER FORMS.
Actualizado December 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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