DERMAVANT SCIENCES, INC.
Dermavant RxAssist Patient Assistance Program
Information last checked June 16, 2023
Contact info
- Phone
- 1-833-762-8268
- Mailing address
- 3780 Kilroy Airport WaySte 250Long Beach, CA 90806
Eligibility
- Uninsured Patients Only
- You have existing Medicaid or Medicare coverage and can attest to financial hardship, or VTAMA (tapinarof) cream, 1% isn't covered
- Program also provides co-pay assistance.
- Patient must be at least 18 years of age and a resident of the United States.
- Patient must have a prescription for VTAMA (tapinarof) cream, 1%.
- Visit program website to apply online.
- Income limit, single
- 250% of the federal poverty level
- Income limit, couple
- 250% of the federal poverty level
- 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
- Proof of income
- 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
- Medication
- Shipped to
- Patient
- Supply per shipment
- 1 tube
- Time to first delivery
- 0–2 weeks
- Refills
- Not published
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- VTAMA (Tapinarof)