Contact info
- Phone
- 1-866-809-9515
- Fax
- 1-866-806-0775
- Mailing address
- PO Box 2889Columbus, OH 43216
Eligibility
- Patients who do not have insurance, or who cannot afford their medicine even with prescription drug coverage, may be eligible for free product if certain financial, medical, and/or insurance criteria are met.
- Program offers co-pay 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
- 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
- Not published
Getting the medication
- Patient receives
- Not published
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact the program
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Bildyos (denosumab-nxxp)
- Bilprevda (denosumab-nxxp)
- Ontruzant (trastuzumab-dttb injection; iv)
- Renflexis (infliximab-ABDA)
- Tofidence (tocilizumab-bavi)