Contact info
- Phone
- 1-844-835-6947
- Fax
- 1-844-475-8931
Eligibility
- Eligibility is determined on a case-by-case basis.
- Program provides co-pay assistance, reimbursement 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
- 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
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Pharmacy card
- Shipped to
- Patient
- Supply per shipment
- 90-day supply
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- New application every 12 months
Medications covered
- Envarsus XR (tacrolimus extended-release tablets)