Daraprim Prescription Assistance Programs

Daraprim: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Daraprim. 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.

Looking for a different medication?

Daraprim Direct Program

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

Provided by: Vyera Pharmaceuticals, LLC
None
TEL: 877-258-2033
ALT PHONE: 877-258-2033
FAX: 877-241-1365
Languages Spoken:
English, Others By Translation Service
Program Website
Program Applications and Forms
Medications
  • Daraprim tablet (pyrimethamine tablet)
Eligibility Requirements
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within 24-48 hours
Medication
  • Amount/Supply Not specified
  • Sent To Doctor's office or patient's home
  • Delivery Time Once approved; within 2 business days
  • Refill Proces Company contacts patient to arrange
  • Limit Not specified
  • Re-application Not specified
Additional Information
None
Updated July 29, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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