The Physician, Physician Assistant, Office Manager, or Social worker enters the site clicks on the Patient Assistance Application link, chooses from the available products, fills in the application, and depending on manufactures, either prints and faxes the application for signature verification or mails the printed application to the proper address.
Patients can initiate the patient assistance process in a few simple steps online by entering your contact information and select the medication for which you are applying; review the program guidelines and requirements that will be listed on your screen. After you submit, follow the instructions and print out your request for your healthcare provider to complete Please Note: If your healthcare provider is unable to complete your request online, you can print out the blank application for you and your healthcare provider to fill out.
Accessible Location: No
|Type of Organization||Other|
|Categories||Financial, Medical, Prescription Assistance|
|Spanish Services Offered?||No|
|Child Care Available?||No|
|Age Range||All ages|
|Disability Categories||Developmental Disability, Genetic Disorder, Intellectual Disability, Learning Disability, Medical Condition, Mental Health Disorder, Physical Disability|
|This organization pertains to all disabilities?||Yes|
|This organization pertains to these specific diagnoses|
|Is this a statewide service?||No|