Contact info
- Phone
- 1-833-213-9520
- Fax
- 1-877-991-1798
- Mailing address
- 6000 Park LanePittsburgh, PA 15275
Eligibility
- Patient must not have insurance.
- Patients with Medicare, Medicaid, and other types of government insurance coverage may not be eligible.
- Program provides co-pay assistance, reimbursement support, and patient assistance programs for eligible patients.
- Income limit, single
- 500% of the federal poverty level
- Income limit, couple
- 500% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- 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
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Varies
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Program contacts physician's office
- Staying enrolled
- Not published
Medications covered
- Fensolvi (leuprolide acetate)