Contact info
- Phone
- 1-844-876-3358
- Fax
- 1-833-851-4344
- Mailing address
- 2730 S. Edmonds Lane, Suite 300Lewisville, TX 75067
Eligibility
- Patient must not be enrolled in a government-sponsored program and must meet certain other eligibility criteria to qualify for this program.
- Patients with Medicare may be eligible for assistance, contact program for details.
- Program provides co-payment assistance, reimbursement support, and patient assistance programs for eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- 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
- Not published
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider
Getting the medication
- Patient receives
- Varies
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published