Drug Information
Drug	Clozaril
Class	schizophrenia
Topic	Neuro/ Mental Health
Program Contact Info / Application Submission
Program	Clozaril Patient Assistance Program
Company	NovCMNS
Address	PO Box 66531 St. Louis, MO 63166
Phone	800-277-2254
Fax	866-470-1750
Program Details
Details	the medication is sent to the doctors office
Program Requirements
Information	Not applicable/
Details	Insurance card required Drivers license required Proof of Income NOT 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 NOT required as proof of income Most recent check/check stub copy NOT required as proof of income Letter from employer accepted as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement NOT required as proof of income Award Letter for Alimony/Child Support, Unemployment NOT required as proof of income Notarized statement from patient stating zero income accepted as proof of income
Delivery of Medication
Delivery Options	Can be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
App Process	The patient or doctor should call the about phone number and select the appropriate prompt for the medication to obtain additional information and next steps.
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can apply for a new application via phone Can apply for a new application via fax Can NOT apply for a new application via mail
Refills	Refills NOT accepted Patients can apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can NOT apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can Re-Apply via phone Can Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals NOT accepted Patients can NOT 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 apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can apply for an appeal via fax on a case by case basis Can NOT apply for an appeal via mail
Eligibility
Eligibility	The patient must have no prescription coverage for the requeted medication and the patient must also be a US resident
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are NOT eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are eligible if the medication is not covered under Medicare Patients are eligible if Medicare coverage has been exhausted
Appeals
Conditions	Appeals will consider out-of-pocket expenses Appeals will consider total medical expenses
Other Medications
Other  Medications  available in  this program	Clozaril - schizophrenia Neuro/ Mental Health (Generic: )