Program Contact Info / Application Submission
Program	Safety Net Foundation for Kineret
Company	AmgenKin
Address	PO Box 13185, La Jolla, CA 92039-3185
Phone	888-762-6436
Fax	800-981-6690
Website	http://www.kineretrx.com/professional/reimbursement/obtaining.jsp
Program Details
Details	Up to a 60-day supply is shipped to either the doctor�s office or the patient�s home. Patients must contact the company to arrange for refills. A new application is needed each year.
Program Requirements
Information	The Physician must fill out their section, sign the application and attach a prescription. The patient must also fill out their section and sign the application.
Details	Insurance card required Drivers license required Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero income required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy required as proof of income Letter from employer required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income required as proof of income
Delivery of Medication
Delivery Options	Can NOT be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
App Process	With the patient�s permission, anyone can call and request an application. Applications will be faxed out. Completed applications can either be faxed or mailed back. Decision is usually made within 5-7 business days.
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 NOT 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 apply for refills Advocates can 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 NOT 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	Patients must not have any prescription coverage OR have reached their cap and meet the income guidelines, which are not disclosed. Patients must also be a US resident. Patients who are Medicare Part D eligible, but did not enroll, may still be eligible for this program.
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage 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 are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D 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 NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied on a case by case basis