Program Contact Info / Application Submission
Program	Kos Cares Patient Assistance
Company	KOS
Address	2100 N. Commerce Parkway, Weston, Fl. 33326
Phone	866-363-1024
Fax	954-331-3778
Website	http://kospharm.com/kos.asp?sec=7&page=76
Program Details
Details	Up to a 90-day supply is shipped to the doctor�s office. A new prescription is required for each refill and may be faxed in. Every year a new application will have to be submitted. Recently the KOS patient assistance program was purchased by Abbott. As of June 1, 2007, they will no longer accept the KOS form.
Program Requirements
Information	The doctor fills out the prescribing section, signs the application, and attaches a prescription. The patient must also fill out their section, sign the application and attach any proof of income. Proof of income must be from within the last 6 months and they will only accept this year's Social Security award letter.
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
Ship Time	up to 8-weeks
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	A doctor or nurse can call for an application. All completed applications must be mailed back. The doctor is notified if patient is accepted or denied.
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 NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can 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 NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can apply for an appeal via phone Can NOT apply for an appeal via fax Can NOT apply for an appeal via mail
Eligibility
Eligibility	The patient can have no prescription coverage for the medication being requested and have an income at or below 200% of the Federal Poverty Guidelines. If patient is eligible for Medicare Part D and does not enroll, they may still be eligible for this program.
Limitations	Patients are eligible with existing prescription coverage Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D
Appeals
Conditions	Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses