Programas de asistencia al paciente para Sylatron

Solicite apoyo para su receta con Sylatron

Si califica, los programas a continuación le pueden ser útiles para conseguir Sylatron. 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 Patient Assistance Program

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

Provienen de: Merck Patient Assistance, Inc.
PO Box 690 Horsham, PA 19044-9979
TEL: 800-727-5400
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Sylatron (peginterferon alfa-2b)
Requisitos de Elegibilidad
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Not specified
  • 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 Sent to doctor or patient
  • Returning Mail original application. Do not fax
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section and sign
  • Decision Communicated Call for decision
  • Decision Timeframe Up to 10 business days
Medicamento
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Patient requests refills via a toll-free number
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
At Merck we realize that sometimes exceptions need to be made based on the patient's individual circumstances. Individuals who do not meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial hardship, and their income meets the program criteria. *The Enrollment Form must be mailed. Please do not fax.
Actualizado November 8, 2018

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HealthWell Foundation Copay Program

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

Provienen de: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Sylatron (peginterferon alfa-2b)
Requisitos de Elegibilidad
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • 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 November 1, 2018

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Patient Access Network Foundation (PAN)

(Programa 3 de 3 — 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
  • Sylatron (peginterferon alfa-2b)
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 Medically appropriate condition/diagnosis
  • 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 July 10, 2018

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