Contact info
- Phone
- 1-877-882-5950
- Fax
- 1-877-885-1103
- Mailing address
- 1120 Win DriveBethlehem, PA 18017-7059
Eligibility
- Determined on case-by-case basis.
- Physicians must apply for this program on behalf of their patients.
- Patients with Medicare Part D are not eligible.
- This program also provides copay assistance and has a Nutritional Rebate Program.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- US citizenship or residency required
- Not published
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
- DEA number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Up to 3-month supply
- Time to first delivery
- 0–2 weeks
- Refills
- 3 refills
- Staying enrolled
- New application every 3 months
Medications covered
- Pertzye capsule (amylase/lipase/pancrelipase/protease)