RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

GILEAD SCIENCES
Ranexa Connect Patient Assistance Program

Ranexa (ranolazine extended-release tablets)
 
CONTACT INFO
Address: PO Box 13185
La Jolla, CA 92039-3185
Phone: 1-888-726-3925 Provider Phone:
Fax: 1-888-568-9228 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Ranexa Connect is a support network that helps patients, physicians and pharmacists with reimbursement and coverage questions about Ranexa. The program addresses a variety of reimbursement topics, including assistance with prior authorization, Medicare Part D assistance and insurance eligibility. As part of this program, Gilead also provides assistance to qualified patients in the United States who cannot afford to pay for Ranexa.
  • Income at or below: Single 300 % FPL
      Couple 300 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: No
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Prescription
    Not Published
    Physician License #
    Required:
    DEA
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Product will go to patient’s home unless it is requested on the application to go to the doctor’s office.
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy: Not Published
    Refill Policy: Patient/Provider will need to contact the program regarding refills.
    Other Information:

    Last Updated: 05/09/2014

     

     

     


    Application Forms
    & Instructions

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


    DocumentForm (English)


    Document Instructions (English)



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2012, RxVantage, all rights reserved.