Contact info
- Phone
- 1-877-722-9786
Eligibility
- Patient eligibility determined on case-by-case basis.
- Patients with Medicare Part D should contact the program for details.
- Program offers co-pay assistance, reimbursement support, patient 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
- 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
- Copy of front and back of insurnace cards, if applicable.
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- 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 contacts the pharmacy
- Staying enrolled
- New application every 12 months
Medications covered
- Cayston (aztreonam for inhalation solution)