Programas de asistencia al paciente para Soliqua

Solicite apoyo para su receta con Soliqua

Si califica, los programas a continuación le pueden ser útiles para conseguir Soliqua. 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 2 — 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
  • Soliqua (insulin glarine/lixisenatide)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
  • Those with Part D Elibible? Considered on exception basis
  • Income At or below 500% of FPL for oncology products and at or below 250% of FPL for all other products
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be a US citizen or permanent resident and treated by a US licensed healthcare provider
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. *On most medications, excluding Lovenox, patients with Medicare Part D may be considered if they are not eligible for Low Income Subsidy, and they have spent at least 5% of annual household income on out-of-pocket costs for medications.
Actualizado August 8, 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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TeamingUp for Diabetes Savings & Support

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

Provienen de: Sanofi-Aventis U.S. LLC
None
TEL: 833-813-0190
ALT PHONE: 833-813-0190
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Soliqua (insulin glarine/lixisenatide)
Requisitos de Elegibilidad
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not Required
  • Diagnosis/Medical Criteria *See Additional Information section below
  • U.S. Residency Required? US residency requirements are not specified.
Solicitud
  • Obtaining Enroll online
  • Receiving Must apply online
  • Returning Complete online or by phone
  • Doctor's Action Not applicable
  • Applicant's Action Call or enroll online
  • Decision Communicated Not applicable
  • Decision Timeframe Not applicable
Medicamento
  • Amount/Supply Not applicable. *See Additional Information section below
  • Sent To Not applicable
  • Delivery Time Not applicable
  • Refill Proces Not applicable
  • Limit Not applicable
  • Re-application Not applicable
Información Adicional
Provides several types of assistance to individuals who have diabetes Education and support services are available; Contact program for details.
Actualizado August 8, 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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