Contact info
- Phone
- 1-866-896-5674
- Fax
- 1-800-910-4610
- Mailing address
- 2503 E. 54th St. N.Sioux Falls, SD 57104
Eligibility
- Patient should contact program for prescreening prior to completing application.
- Patient must have no prescription coverage for needed medication.
- Patients with Medicare Part D may be considered on an exceptions basis. Call program for details.
- Income limit, single
- 300% of the federal poverty level
- Income limit, couple
- 300% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- Up to 3-month supply
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
More from the program
- Approved patients may receive up to a 3-month supply of medication at a time, for up to 12 months, subject to continued eligibility and pursuant to a valid prescription.
Medications covered
- Tymlos (abaloparatide)