Keveyis Prescription Assistance Programs

Keveyis: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Keveyis. 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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Strongbridge CareConnection Patient Support Program (Keveyis)

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

Provided by: Strongbridge Biopharma plc.
PANTHERx Specialty Pharmacy 24 Summit Park Dr. Pittsburgh, PA 15275
TEL: 844-538-3947
FAX: 844-538-1030
Languages Spoken:
English
Program Website
Medications
  • Keveyis tablet (dichlorphenamide tablet)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? US residency requirements are not specified.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Patient contacts pharmacy
  • Limit Varies
  • Re-application Patient contacts program
Additional Information
This program provides copay assistance. Education and support services are available; Contact program for details.
Updated December 4, 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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