Contact info
- Phone
- 1-888-694-2686
- Fax
- 1-877-375-0758
Eligibility
- Patient must be uninsured or underinsured.
- Patients with Medicare Part D are not eligible.
- Co-pay assistance also available.
- Income limit, single
- 400% of the federal poverty level
- Income limit, couple
- 400% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- 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 published
- 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
- Not published
- Time to first delivery
- Not published
- Refills
- Program contacts patient
- Staying enrolled
- New application every 12 months
Medications covered
- Gamunex-C (immune globulin; intravenous)