Contact info
- Phone
- 1-888-765-4747
Eligibility
- Eligibility determined on case-by-case basis.
- Patient with Medicare Part D are not eligible.
- This program also provides co-pay assistance.
- 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
- Not published
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
- Not published
- Who can sign
- Not published
- Application can be faxed
- Not published
- 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
- Not published
- Staying enrolled
- Not published
Medications covered
- Kanuma (sebelipase alfa)
- Koselugo (selumetinib)
- Soliris (eculizumab)
- Strensiq injection (asfotase alfa injection)
- Ultomiris (ravulizumab-cwvz injection; iv)
- Voydeya (danicopan)