Programas de asistencia al paciente para Perjeta

Solicite apoyo para su receta con Perjeta

Si califica, los programas a continuación le pueden ser útiles para conseguir Perjeta. 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 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
  • Perjeta (pertuzumab)
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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HealthWell Foundation Copay Program

(Programa 2 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
  • Perjeta (pertuzumab)
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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Genentech Patient Foundation

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

Provienen de: Genentech USA, Inc.
None
TEL: 888-941-3331
FAX: 833-999-4363
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Perjeta (pertuzumab)
Requisitos de Elegibilidad
  • Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
  • Those with Part D Elibible? Contact program for details.
  • Income Income Guidelines published on Program Website
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
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 Complete section and sign
  • Applicant's Action Complete section and sign
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Varies
Medicamento
  • Amount/Supply Amount requested is sent
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Varies
  • Refill Proces Varies per medication
  • Limit Not specified
  • Re-application Not specified
Información Adicional
The Genentech Access to Care Foundation is now the Genentech Patient Foundation. Eligibility determined on a case-by-case basis. Call for most recent medications as the list is subject to change.
Actualizado June 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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Genentech Access Solutions BioOncology

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

Provienen de: Genentech USA, Inc.
1 DNA Way, Mail Stop #858a South San Francisco, CA 94080-4990
TEL: 888-249-4918
ALT PHONE: 888-249-4918
FAX: 888-249-4919
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Perjeta (pertuzumab)
Requisitos de Elegibilidad
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Determined case by case
  • Income Based on FPL
  • Diagnosis/Medical Criteria Varies
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed, emailed, mailed or downloaded
  • Returning Fax, mail or submit online (Note: faxed prescriptions are only valid if faxed directly from a prescriber's office)
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Patient or patient representative signs authorization form
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Varies
Medicamento
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Contact Program for Details
  • Refill Proces Doctor/Doctor's office must contact company
  • Limit One year
  • Re-application Contact program for details.
Información Adicional
Call for most recent medications as the list is subject to change.
Actualizado June 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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