![]() ![]() Patients must be a US resident.Īnyone requesting assistance can call to request a faxed application or download it from the website. There are no income limits for this program. Note: All new enrollment is now done electronically or over the phone. *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.Ĭall 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. Doctors action will be discussed with the patient and doctor after the request is received. Patients must call for information or inform their doctor that they are in need. Patients or healthcare providers can complete the application online or by phone. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. Patient with Medicare Part D will be considered on a case by case basis. The patient's insurance must cover the qualifying medication that they are seeking assistance for. This is a copay assistance program for patients that have health insurance. NOTE: Linked drugs are available for Prescribers to Apply Online now.Ĭlick drug logo or drug name to start online application.Īpplications that patients can fill out and bring to their doctor.ĭownload printable Form Advancing Access Program IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs. The other medications are given using a pharmacy card. If the application is for Vistide, then prescription must be included because it will be sent to the doctor's office. Insurance benefits, claims assistance and/or other reimbursement help is offered. Patient must complete application, sign, and attach proof of income.Īmount/Supply varies. Doctor must complete and sign application. Medically appropriate condition/diagnosis required. ![]() Patient and Doctor notified in writing of decision in 3-5 business days. Must be a US residentĬall for application to be faxed or mailed. Medicare Part D patients are not eligible for this program. This program is intended for patients that are uninsured. ![]()
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