Contact info
- Phone
- 1-855-676-6326
- Fax
- 1-855-557-2478
Eligibility
- Patients must be uninsured or rendered uninsured.
- Patients with Medicare Part D may be eligible, determined on case-by-case basis.
- For Lemtrada, contact program for application.
- 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
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Patient
Getting the medication
- Patient receives
- Varies
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Refills are sent automatically
- Staying enrolled
- Not published
More from the program
- Co-pay assistance may also be available.
Medications covered
- Lemtrada (alemtuzumab)