rxhelp360.org
| Drug Information | ||||||||||||||
| Drug | Viokase 16 | |||||||||||||
| Generic Equivalent | pancrelipase | |||||||||||||
| Topic | Organs | |||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||
| Program | ASSIST Program | |||||||||||||
| Company | Axcan Pharma | |||||||||||||
| Address | PO Box 52065, Phoenix, AZ 85072-9152 | |||||||||||||
| Phone | 866-292-2679 | |||||||||||||
| Program Details | ||||||||||||||
| Details | The patient is sent a pharmacy card, which is to be used once a month. The application process must be repeated once a year. | |||||||||||||
| Program Requirements | ||||||||||||||
| Information | Both the doctor and patient must fill out their section and sign the application. | |||||||||||||
| Details | Insurance card NOT required Drivers license NOT required | |||||||||||||
| Other Requirements | There is a $3.00 dispensing fee for each prescript | |||||||||||||
| 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 | Doctors, patient, social workers or patient advocates need to call for a prescreening. Applications are sent to either the doctor or the patient. Completed applications must be mailed back. The decision is made during the phone screening and then application is sent. | |||||||||||||
| 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 | |||||||||||||
| 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 | |||||||||||||
| Eligibility | ||||||||||||||
| Eligibility | Patients can not have any prescription insurance, not be ineligible for any government programs, in addition, the must have an income at or below 200% of the Federal Poverty Level. | |||||||||||||
| Other Medications | ||||||||||||||
| Other Medications available in this program |
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