Serostim Patient Assistance Programs

Serostim: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Serostim. 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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Serostim Patient Assistance Program

(Program 1 of 3 — Scroll down to see them all)

Provided by: EMD Serono, Inc.
PO Box 9535 Louisville, KY 40255
TEL: 877-714-2947, opt. 2 then 4
FAX: 866-823-9554
Languages Spoken:
English Others By Translation Service
Program Website
Medications
  • Serostim injection (somatropin (rDNA origin) injection)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must reside in the US, District of Columbia, or Puerto Rico and have a prescription from a U.S. licensed doctor.
Application
  • Obtaining Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form
  • Receiving Sent to the patient's home
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete and fax Statement of Medical Necessity and signed Patient Authorization forms which are on the website
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe 2 business days, once application process is complete
Medication
  • Amount/Supply Up to 3 months supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application needed 1 year from date of prescription on original application
Additional Information
Patients must first go through their insurance investigation process and must be referred by the AXIS Center case manager to the PAP. If they are referred to the PAP, they will receive an application to be completed. Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more than once every 21 days. Company will cover up to $1,500 per month.
Updated August 27, 2018

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

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Good Days Program

(Program 2 of 3 — 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
  • Serostim (somatropin (rDNA origin))
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 August 2, 2018

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

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Patient Access Network Foundation (PAN)

(Program 3 of 3 — 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
  • Serostim (somatropin (rDNA origin))
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

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

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