Contact info
- Phone
- 1-800-367-4999
- Fax
- 1-888-275-8593
Eligibility
- Patient must be uninsured or underinsured.
- Patients with Medicare Part D may be eligible.
- Program offers co-payment 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
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Copy of Insurance denial, if applicable.
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Varies
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact program.
- Staying enrolled
- Not published
More from the program
Prescribing Physician, Healthcare Facilites, Pharmacies and Patients must enroll into the Risk Evaluation and Mitigation Strategy (REMS) Program prior to initiating the patient on treatment with Caprelsa.
Medications covered
- Caprelsa (vandetanib)