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Program Details

AMGEN, INC.
ENcourage Foundation

Enbrel (etanercept)
 
CONTACT INFO
Address: PO Box 5730
Louisville, KY 40255-0730
Phone: 1-800-282-7752 Provider Phone:
Fax: 1-888-508-8083 Website: Encourage Foundation
ELIGIBILITY
Eligibility Info:
  • Eligible patients must be U.S. residents, demonstrate financial need, and have no or limited drug coverage. Qualifying Medicare Part D paients may also be eligible.
  • Income at or below: Single $33,510 % FPL
      Couple $45,390 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: None
    Physician License #
    Required:
    State
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: 2-4 weeks
    Re-application Policy: New application every 12 months
    Refill Policy: Program will contact the patient to arrange refills.
    Other Information:

    Last Updated: 05/07/2013

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)



     

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