rxhelp360.org
| 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 required Drivers license required | |||||||||
| Other Requirements | There is a $3.00 dispensing fee for each prescript | |||||||||
| Delivery of Medication | ||||||||||
| Delivery Options | Can NOT be delivered directly to the patient Can be delivered directly to the doctor | |||||||||
| 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 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 | |||||||||
| 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 | |||||||||
| 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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