Contact info
- Phone
- 1-866-664-5327
Eligibility
- Patient must meet program guidelines which are not disclosed.
- Eligibility for Medicare Part D patients is determined on a case-by-case basis.
- Co-pay assistance is also available.
- 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
- None
- Prescriber license number
- Not published
- 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
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact pharmacy
- Staying enrolled
- Reapplication is determined on a case-by-case basis
Medications covered
- Letairis Tablets (ambrisentan)