Contact info
- Phone
- 1-877-968-7233
- Fax
- 1-214-570-3621
- Mailing address
- Attn: Enrollment2611 Internet Blvd., Suite 105Frisco, TX 75034
Eligibility
- Call for most recent medications list as is subject to change based on available funding.
- Patients must have valid medical insurance coverage. Patients who are applying for copayment assistance must have at least 50% insurance coverage or more to be eligible for copayment assistance, excluding deductibles.
- Patients must have been prescribed a medication that is part of the Good Days formulary.
- Patients must meet our annual household income criteria.
- 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
- 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
- Proof of income
- Prescriber license number
- Not required
- Who can sign
- Not published
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Not published
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Must reapply at the end of the calendar year.
Medications covered
- Agrylin (anagrelide hydrochloride)
- Aptivus capsules (tipranavir)
- Atripla (efavirenx/emtricitabine/tenofovir disoproxil fumarate)
- Beovu (brolucizumab-dbll)
- Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)