Contact info
- Phone
- 1-877-473-3179
- Fax
- 1-877-473-3049
Eligibility
- Eligibility is determined on case-by-case basis.
- Patients enrolled in Medicare Part D are not eligible.
- Program also provides co-pay assistance.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- 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
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- 0–2 weeks
- Refills
- Refill form included with each shipment
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Orfadin (nitisinone)