Contact info
- Phone
- 1-855-769-7284
- Fax
- 1-855-298-8700
- Mailing address
- P.O. Box 13185La Jolla, CA 92039-3185
Eligibility
- Patient must uninsured or underinsured.
- Visit Program Website to apply online.
- This program also provides copay assistance.
- Income limit, single
- 500% of the federal poverty level
- Income limit, couple
- 500% of the federal poverty level
- 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 any insurance information, if applicable.
- Prescriber license number
- NPI number
- State license number
- 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 or patient
- Supply per shipment
- Up to 28 day supply
- Time to first delivery
- 0–2 weeks
- Refills
- Program contacts patient to arrange refills.
- Staying enrolled
- Not published
Medications covered
- Epclusa (sofosbuvir/velpatasvir tablet)
- Harvoni tablet (ledipasvir/sofosbuvir)
- Hepcludex (bulevirtide-gmod)
- Livdelzi (seladelpar)
- Vemlidy (tenofovir alafenamide)
- Vosevi (sofosbuvir, velpatasvir, and voxilaprevir)