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Danazol Patient Assistance Programs

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Or go to the main Patient Assistance Programs page>>

: Apply for prescription assistance below


If you are eligible, the programs below can help you afford . 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 PharmacyChecker.com) or go to the program website.



HealthWell Foundation Copay Program


Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410

TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
 

Program Applications and Forms

  • HealthWell Foundation Copay Program: Contact program

Medications

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? The patient must also be residing in the US.

Application
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

Medication
Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months

Additional Information
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.

Updated 5/22/2017

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