Programas de asistencia al paciente para Pentasa

Solicite apoyo para su receta con Pentasa

Si califica, los programas a continuación le pueden ser útiles para conseguir Pentasa. 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 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
  • Pentasa (mesalamine)
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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Shire Cares

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

Provienen de: Takeda Pharmaceutical
Shire Cares Patient Assistance & Support Program PO Box 5666 Louisville, KY 40255-0666
TEL: 888-227-3755
FAX: 877-922-7379
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Solicitudes y Formularios
Medicamentos
  • Pentasa (mesalamine)
Requisitos de Elegibilidad
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Yes
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
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 proof of income and any insurance information
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe 2-4 business days
Medicamento
  • Amount/Supply 90 day supply
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
Each Application will be considered on a case by case basis.
Actualizado August 5, 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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