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Danazol Patient Assistance Programs

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: 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

(Program 1 of 2. Scroll down to see them all.)

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

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 11/18/2016

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Patient Access Network Foundation (PAN)

(Program 2 of 2. Scroll down to see them all.)

Provided by: Patient Access Network Foundation
PO Box 221858 Charlotte, NC 28222-1858 TEL: 866-316-7263 FAX: 866-316-7261	Languages Spoken: English, Spanish, Others By Translation Service Program Website

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program
Patient Access Network Foundation (PAN) Provider Brochure (PDF)
Patient Access Network Foundation (PAN) Patient Brochure (PDF)

Eligibility Requirements
Insurance Status	*See Additional Information section below
Those with Part D Eligible?	Determined case by case
Income	Between 400-500% of FPL
Diagnosis/Medical Criteria	Medically appropriate condition/diagnosis
US Residency Required?	Must reside and receive treatment in US

Application
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

Medication
Amount/Supply	Not applicable
Sent To	Patient sent card to be used at pharmacy
Delivery Time	Once approved; shipped same day
Refill Process	Patient presents voucher/card to pharmacy for each refill
Limit	None
Re-application	New application every 12 months

Additional Information
*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.
Updated 8/2/2016

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Danazol Patient Assistance Programs

: Apply for prescription assistance below

HealthWell Foundation Copay Program

Provided by: HealthWell Foundation

Program Applications and Forms

HealthWell Foundation Copay Program: Contact program

Medications

Eligibility Requirements

Application

Medication

Additional Information

Patient Access Network Foundation (PAN)

Provided by: Patient Access Network Foundation

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

Medications

Eligibility Requirements

Application

Medication

Additional Information