Contact info
- Phone
- 1-877-447-3243
Eligibility
- Patient must have a relapsing form of MS.
- Eligibility determined on case-by-case basis.
- Patient must call for a prescreening.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- 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
- Proof of income
- Prescriber license number
- Not published
- Who can sign
- Not published
- Application can be faxed
- No
- Decision letter sent to
- Patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- 0–2 weeks
- Refills
- Program will contact patient to arrange for refills.
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Mavenclad (cladribine tablet)
- Rebif subcutaneous (interferon beta-1a)