Veltassa Patient Assistance Programs

Veltassa: Apply for prescription assistance below

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

Patient Access Network Foundation (PAN)

(Program 1 of 2 — 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
  • Veltassa (patiromer)
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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VeltassaKonnect

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

Provided by: Relypsa, Inc.
PO Box 43848 Louisville, KY 40253
TEL: 844-870-7597
FAX: 1-888-623-7092
Languages Spoken:
English Spanish
Program Website
Medications
  • Veltassa (patiromer)
Eligibility Requirements
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must reside in the US, DC, Puerto Rico or the USVI
Application
  • Obtaining Call or download
  • Receiving 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. *see below for details
  • Sent To Patient's home
  • Delivery Time Shipped overnight
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
*The patient receives a free 15-day supply of VELTASSA directly—even before coverage is determined. If the benefit verification process takes longer than expected, a second 15-day supply of VELTASSA will be shipped to your patient at no cost.
Updated April 19, 2018

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