Tavalisse Patient Assistance Programs

Tavalisse: Apply for prescription assistance below

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

HealthWell Foundation Copay Program

(Program 1 of 2 — Scroll down to see them all )

Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Tavalisse (fostamatinib)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • 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 November 1, 2018

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Rigel OneCare Patient Assistance Program

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

Provided by: Rigel Pharmaceuticals Inc.
4060 Wedgeway Ct. Earth City, MO 63045
TEL: 833-744-3562
FAX: 833-397-4435
Languages Spoken:
English
Program Website
Medications
  • Tavalisse (fostamatinib)
Eligibility Requirements
  • Insurance Status Must not have insurance
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? US residency requirements are not specified.
Application
  • Obtaining Call, download or apply online
  • Receiving Faxed or 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 Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit One year
  • Re-application New financial documentation needed yearly
Additional Information
None
Updated June 14, 2018

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