Ocaliva Patient Assistance Programs

Ocaliva: Apply for prescription assistance below

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

Interconnect Support Services Patient Assistance Program

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

Provided by: Intercept Pharmaceuticals, Inc.
Interconnect PO Box 580 Somerville, NJ 08876
TEL: 844-622-4278
FAX: 855-686-8730
Languages Spoken:
English
Program Website
Medications
  • Ocaliva (obeticholic acid)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
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 Patient and Doctor are notified
  • Decision Timeframe 5-7 business days
Medication
  • Amount/Supply Amount requested is sent
  • Sent To Patient's home
  • Delivery Time Varies
  • Refill Proces Company contacts patient to arrange
  • Limit One year
  • Re-application New application yearly
Additional Information
This program also provides copay assistance.
Updated October 18, 2018

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