Programas de asistencia al paciente para Prevymis

Solicite apoyo para su receta con Prevymis

Si califica, los programas a continuación le pueden ser útiles para conseguir Prevymis. 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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Merck Connect

(Programa 1 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Merck & Co., Inc.
None
TEL: 800-489-5119
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • Prevymis (letermovir)
Requisitos de Elegibilidad
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Determined case by case
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
Solicitud
  • Obtaining Enroll online
  • Receiving Not specified
  • Returning The completed application's destination is not specified
  • Doctor's Action Enroll in the program
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medicamento
  • Amount/Supply Up to 30 day supply
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Información Adicional
Resources for HEALTHCARE PROFESSIONALS ONLY. The Physician must register to access tools and materials for patient support, product sample requests, up-to-date professional resources, and other Merck professional sites.
Actualizado September 16, 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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Merck Access Program for Prevymis

(Programa 2 de 3 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Merck Patient Assistance, Inc.
Merck Access Program PO Box 29067 Phoenix, AZ 85038
TEL: 855-404-5278
FAX: 866-866-4127
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Prevymis (letermovir)
Requisitos de Elegibilidad
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • 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 or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medicamento
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Patient must contact company
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
Patient must sign the enrollment form to give the program permission to access their financial information in order to determine eligibility. Patients in need who appear not to qualify should still call.
Actualizado July 3, 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 3 de 3 — 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
  • Prevymis (letermovir)
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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