Programas de asistencia al paciente para Valcyte

Solicite apoyo para su receta con Valcyte

Si califica, los programas a continuación le pueden ser útiles para conseguir Valcyte. 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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Genentech Access to Care Foundation (HIV & Transplants)

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

Provienen de: Genentech, Inc.
PO Box 29064, Phoenix, AZ 85038
TEL: 888-754-7651
FAX: 800-305-1830
Idiomas hablados:
English, Spanish, Others By Translation Service
La Página del Programa
Medicamentos
  • Valcyte (valganciclovir)
Requisitos de Elegibilidad
  • Insurance Status Uninsured or Underinsured
  • Those with Part D Elibible? Determined case by case
  • Income Household income at or less than $150,000
  • Diagnosis/Medical Criteria Not applicable
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
Solicitud
  • Obtaining Doctor/Doctor's office starts process by filling out enrollment/statement of medical necessity forms
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete and sign statement of medical necessity
  • Applicant's Action Complete Patient Authorization and Notice of Information Form available on website, attach proof of income
  • Decision Communicated Patient and/or Doctor are notified
  • Decision Timeframe 2 business days, once application process is complete
Medicamento
  • Amount/Supply Contact the program for more details.
  • Sent To Doctor's office or patient's home
  • Delivery Time Contact Program for Details
  • Refill Proces Contact program for details.
  • Limit Contact the program for details
  • Re-application Contact program for details.
Información Adicional
This program also provides copay assistance.
Actualizado October 15, 2018

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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