| CONTACT
INFO |
|
| Address: |
PO Box 2355
Morristown, NJ 07962 |
| Phone: |
1-833-364-3788 |
Provider Phone: |
|
| Fax: |
1-833-904-1851 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
If you are uninsured, underinsured, or a Medicare patient and you cannot afford your medicine, you may be able to get help from our Patient Assistance Programs. Patient Assistance Programs (PAP) can provide ENHERTU for free if you qualify.
Call program for more information on how to enroll and determine eligibility. |
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Not
Published |
| US citizenship/residency specified:
|
Not
Published |
|
|
APPLICATION |
|
| Attachments
Required: |
|
Physician
License #
Required: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Yes
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Provider
|
| Quantity in
Shipment: |
1 Dose |
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
New application every 12 months
New financial information every 12 months
|
| Refill Policy: |
Refills can be requested by calling the program. |
| Other Information: |
Enrollment is on a calendar year basis for Medicare patients. Enrollment is on a rolling annual basis for uninsured patients. Patients have opportunity to re-enroll at the end of their eligibility period. |
|