Contact info
- Phone
- 1-866-349-3026
- Fax
- 1-844-737-3493
Eligibility
- Patient must be uninsured or underinsured.
- Program provides co-pay and patient assistance to eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- 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
- DEA number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact program
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Dayvigo (lemborexant tablet)