Contact info
- Phone
- 1-844-438-5469
- Fax
- 1-844-364-2424
Eligibility
- Eligibility is determined on a case-by-case basis.
- Patients with Medicare Part D may be eligible.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- 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
- Provider and patient
Getting the medication
- Patient receives
- Not published
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient contacts pharmacy
- Staying enrolled
- Not published
More from the program
- Co-pay assistance is also available.
Medications covered
- Hetlioz (tasimelteon capsule)