Afinitor Disperz Patient Assistance Programs

Afinitor Disperz: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Afinitor Disperz. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not or go to the program website.

Looking for a different medication?

Novartis Patient Assistance Foundation, Inc.

(Program 1 of 1 — Scroll down to see them all )

Provided by: Novartis Pharmaceuticals
PO Box 52029 Phoenix, AZ 85072-2029
TEL: 800-277-2254
FAX: 855-817-2711
Languages Spoken:
English Spanish Others By Translation Service
Program Website
  • Afinitor Disperz (everolimus)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident.
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach prescription for 90 days
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Doctor notified via mailed letter
  • Decision Timeframe Not specified
  • Amount/Supply Varies
  • Sent To Doctor's office or patient is sent card to be used at pharmacy
  • Delivery Time Not specified
  • Refill Proces Refill/reorder form included with shipment
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician. *Additional products may be available. Please contact the program for a complete product listing.
Updated August 8, 2018

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