Contact info
- Phone
- 1-844-225-5894
- Fax
- 1-877-850-9901
Eligibility
- Patient must not have any insurance and must not be eligible for any state or federal programs.
- Patient's with Medicare Part D should contact the program for details.
- Patient's with insurance may qualify for the Co-Pay Assistance Program.
- 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
- Proof of income
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- 0–2 weeks
- Refills
- Program contact's physician's office.
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Benlysta (belimumab)