Contact info
- Phone
- 1-844-870-7597
- Fax
- 1-888-623-7092
Eligibility
- Program offers co-pay assistance, patient support, and patient assistance programs for eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- 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
- Not published
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Varies
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
More from the program
- The patient receives a free 15-day supply of VELTASSA directly - even before coverage is determined. If the benefit verification process takes longer than expected, a second 15-day supply of VELTASSA will be shipped to your patient at no cost.
Medications covered
- Veltassa (patiromer)