Contact info
- Phone
- 1-877-336-3736
- Fax
- 1-877-556-3737
Eligibility
- Patients may be eligible for paitent assistance if they have no health insurance, including if they do not have drug coverage due to drug benefit carve-out, or are rendered uninsured due to payer claim denial.
- Patients with Medicare Part D are not eligible.
- Program also offers co-payment assistance.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- No
- 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
- 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
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Provenge (sipuleucel-t)