rxhelp360.org
| Drug Information | ||||||||||||||||||||||
| Drug | Azasan 75 mg | |||||||||||||||||||||
| Generic Equivalent | azathioprine tablets | |||||||||||||||||||||
| Topic | Gastroenterology | |||||||||||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||||||||||
| Program | Salix Pharmaceuticals PAP | |||||||||||||||||||||
| Company | Salix | |||||||||||||||||||||
| Form | Download PDF | |||||||||||||||||||||
| Address | P.O. Box 66520, St. Louis, MO 63166-6520 | |||||||||||||||||||||
| Phone | 866-282-6563 | |||||||||||||||||||||
| Fax | N/A | |||||||||||||||||||||
| Website | http://www.salix.com/index.aspx | |||||||||||||||||||||
| Program Requirements | ||||||||||||||||||||||
| Details | Insurance card will be considered on a case by case basis Drivers license NOT required Proof of Income required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero incomeNOT required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements NOT required as proof of income Most recent check/check stub copy NOT required as proof of income Letter from employer NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment accepted as proof of income Notarized statement from patient stating zero income NOT required as proof of income | |||||||||||||||||||||
| Delivery of Medication | ||||||||||||||||||||||
| Ship Time | 7-14 business days | |||||||||||||||||||||
| Delivery Options | Can be delivered directly to the patient Can be delivered directly to the doctor | |||||||||||||||||||||
| Application Process | ||||||||||||||||||||||
| New Applications | New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can NOT apply for a new application via phone Can NOT apply for a new application via fax Can apply for a new application via mail | |||||||||||||||||||||
| Refills | Refills accepted Patients can NOT apply for refills Doctors can apply for refills Advocates can apply for refills Can apply for refills via phone Can NOT apply for refills via fax Can apply for refills via mail | |||||||||||||||||||||
| Re-Applications | Re-Applications accepted Patients can apply for Re-Applications Doctors can apply for Re-Applications Advocates can apply for Re-Applications Can NOT Re-Apply via phone Can NOT Re-Apply via fax Can Re-Apply via mail | |||||||||||||||||||||
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can NOT apply for an appeal via phone Can NOT apply for an appeal via fax Can apply for an appeal via mail | |||||||||||||||||||||
| Eligibility | ||||||||||||||||||||||
| Limitations | Patients are eligible if LIS is denied Patients may be eligible with existing prescription coverage on a case by case basis Patients may be eligible if prescription is not covered on a case by case basis Patients may be eligible if prescription coverage has been exhausted on a case by case basis Patients are eligible if they are accepting Medicare Patients may be eligible if they are accepting Medicare part D on a case by case basis Patients may be eligible if the medication is not covered under Medicare on a case by case basis Patients may be eligible if Medicare coverage has been exhausted on a case by case basis | |||||||||||||||||||||
| Appeals | ||||||||||||||||||||||
| Conditions | Appeals may be consider out-of-pocket expenses on a case by case basis Appeals may be consider total medical expenses on a case by case basis Appeals must be made after the patient has been denied | |||||||||||||||||||||
| Other Medications | ||||||||||||||||||||||
| Other Medications available in this program |
| |||||||||||||||||||||
|
|
||||||||||||||||||||
|
|
||||||||||||||||||||
