Droxia Prescription Assistance Programs

Droxia: Apply for prescription assistance below

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

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Patient Access Network Foundation (PAN)

(Program 1 of 4 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Droxia (hydroxyurea)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
  • U.S. 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 Proces 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 August 6, 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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HealthWell Foundation Copay Program

(Program 2 of 4 — Scroll down to see them all )

Provided by: HealthWell Foundation
P.O. Box 489 Buckeystown, MD 21717
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Droxia (hydroxyurea)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
  • U.S. 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 Proces 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 July 2, 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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Good Days Program

(Program 3 of 4 — Scroll down to see them all )

Provided by: Good Days from CDF
Attn: Enrollment 6900 Dallas Parkway Suite #200 Plano, TX 75024
TEL: 877-968-7233
FAX: 214-570-3621
Languages Spoken:
English
Program Website
Medications
  • Droxia (hydroxyurea)
Eligibility Requirements
  • Insurance Status Must have insurance
  • Those with Part D Elibible? Not specified
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must also be a US resident with a Social Security Number.
Application
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed, mailed or submitted online.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and/or Doctor are notified
  • Decision Timeframe Varies
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Must re-enroll at end of calendar year
Additional Information
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.
Updated May 13, 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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BMS Access Support (Oncology)

(Program 4 of 4 — Scroll down to see them all )

Provided by: Bristol-Myers Squibb Company
Oncolocy Reimbursement Support PO Box 221509 Charlotte, NC 28222-1509
TEL: 800-861-0048
FAX: 888-776-2370
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Droxia (hydroxyurea)
Eligibility Requirements
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • Diagnosis/Medical Criteria Varies
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Doctor notified
  • Decision Timeframe 2 business days, once application process is complete
Medication
  • Amount/Supply Contact the program for more details.
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Must re-enroll at end of calendar year
Additional Information
*This program provides the screening for the Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF) Oncology Patient Assistance Program. This program also provides copay assistance.
Updated May 7, 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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