Program Contact Info / Application Submission
Program	Lovenox Reimbursement Services and Patient Assistance Program
Company	SanofiAventis
Address	P.O. Box 8256 Somerville NJ, 08876
Phone	888-632-8607, opt 2
Fax	888-875-9951
Website	https://patientassistanceprogram.sanofi-aventis.us/brand/lovenox_reimbursement_pat.aspx
Program Requirements
Details	Insurance card NOT required Drivers license NOT 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 incomeNOT required 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 NOT required 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 NOT required as proof of income
Delivery of Medication
Ship Time	5 - 7 business days
Delivery Options	Can NOT be delivered directly to the patient Can be delivered directly to the doctor
Application Process
New Applications	New applications accepted Patients can NOT 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 apply for a new application via fax Can apply for a new application via mail
Refills	Refills accepted Patients can NOT apply for refills Doctors can apply for refills Advocates can apply for refills Can NOT apply for refills via phone Can apply for refills via fax Can apply for refills via mail
Re-Applications	Re-Applications accepted Patients can NOT apply for Re-Applications Doctors can apply for Re-Applications Advocates can apply for Re-Applications Can NOT Re-Apply via phone Can 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 on a case by case basis Patients can apply for Hardship Appeals on a case by case basis Doctors can apply for Hardship Appeals on a case by case basis Advocates can apply for Hardship Appeals on a case by case basis Can NOT apply for an appeal via phone Can apply via fax Can apply for an appeal via mail
Eligibility
Limitations	Patients may be eligible if LIS is denied on a case by case basis 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 may be eligible if prescription coverage has been exhausted on a case by case basis Patients may be eligible if they are accepting Medicare part D on a case by case basis Patients may be eligible if the medication is not covered under Medicare on a case by case basis Patients may be eligible if Medicare coverage has been exhausted on a case by case basis
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 on a case by case basis