Extavia Patient Assistance Programs

Extavia: Apply for prescription assistance below

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

Novartis Patient Assistance Foundation, Inc.

(Program 1 of 4 — 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
Medications
  • Extavia (interferon beta-1b)
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.
Application
  • 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
Medication
  • 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. www.pap.novartis.com
Updated November 19, 2018

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Good Days Program

(Program 2 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
  • Extavia (interferon beta-1b)
Eligibility Requirements
  • Insurance Status Not specified
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? US residency requirements are not specified.
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 October 5, 2018

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Extavia Go Program

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

Provided by: Novartis Pharmaceuticals
Customer Interaction CenterNovartis Pharmaceuticals Corporation One Health Plaza East Hanover, NJ 07936-1080
TEL: 866-925-2333
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Extavia (interferon beta-1b)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Considered on exception basis
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must also be a US resident.
Application
  • Obtaining Call
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach proof of income and any insurance information
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within a week
Medication
  • Amount/Supply Varies
  • Sent To Card obtained from doctor's office
  • Delivery Time Not specified
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application yearly
Additional Information
Eligibility determined on a case-by-case basis.
Updated August 7, 2018

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Patient Access Network Foundation (PAN)

(Program 4 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
  • Extavia (interferon beta-1b)
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 Medically appropriate condition/diagnosis
  • 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 July 10, 2018

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