rxhelp360.org
| Drug Information | ||||||||||
| Drug | Campath | |||||||||
| Generic Equivalent | alemtuzumab | |||||||||
| Topic | Cancer | |||||||||
| Program Contact Info / Application Submission | ||||||||||
| Program | Bayer Patient Assistance Program | |||||||||
| Company | Bayer | |||||||||
| Address | PO Box 29209, Phoenix, AZ 85038-9209 | |||||||||
| Phone | 888-842-2937, opt 7, opt 3 | |||||||||
| Fax | 973-305-3545 | |||||||||
| Website | N/A | |||||||||
| Program Details | ||||||||||
| Details | Patients are sent a pharmacy card.�After six months, a form is mailed out that needs to be completed and returned.�The application process must be repeated once a year. | |||||||||
| Program Requirements | ||||||||||
| Information | Doctors and Patient's must fill out their section and sign the application.and attach proof of income | |||||||||
| Details | Insurance card NOT required 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 income accepted as proof of income Form 4506T (If taxes were not filed) NOT required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy 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 required as proof of income Notarized statement from patient stating zero income accepted as proof of income | |||||||||
| Delivery of Medication | ||||||||||
| Ship Time | 7-10 business days | |||||||||
| Delivery Options | Shipped as a voucher card | |||||||||
| Application Process | ||||||||||
| App Process | Patients or doctors must call for a prescreening. Applications are sent to the doctor�s office. Completed applications must be mailed back. The doctor is notified of acceptance or denial. Decisions are made during the phone screening and then the application is mailed. | |||||||||
| 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 | |||||||||
| 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 apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can NOT apply for an appeal via fax Can apply for an appeal via mail | |||||||||
| Eligibility | ||||||||||
| Eligibility | The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. The patient must be a US citizen or legal US resident. Eligibility is determined on a case by case basis. Any patient who is enrolled in any Government Prescription Programs or Private Prescription Plans including, but not limited to Medicare Part D, Medicaid, State-sponsored Prescription Assistance programs, or has employee, military, retirement, or pension program drug coverage is not eligible for this program. Pharmacy discount cards or other patient assistance programs are not considered coverage | |||||||||
| Limitations | 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 are NOT eligible if prescription coverage has been exhausted 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 are eligible if the medication is not covered under Medicare Patients are NOT eligible if Medicare coverage has been exhausted | |||||||||
| Appeals | ||||||||||
| Conditions | Appeals will consider out-of-pocket expenses Appeals will consider total medical expenses Appeals may be made before the patient has been denied | |||||||||
| Other Medications | ||||||||||
| Other Medications available in this program |
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