Contact info
- Phone
- 1-888-432-5232
- Fax
- 1- 866-212-2888
Eligibility
- Patient must be uninsured.
- Patients with Medicare Part D are not eligible.
- Must meet program income guidelines, which are not disclosed.
- 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 required
- Who can sign
- Physician
- Application can be faxed
- Not published
- Decision letter sent to
- Provider
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Affinity (tissue-human allograft dermal substitute)
- Apligraf (bi-layered skin substitute)
- NuShield (wound dressing)
- PuraPly AM Wound Dressing (wound matrix)
- PuraPly Wound Dressing (wound matrix)