Program Details
SK LIFE SCIENCE, INC.
SK Life Science Navigator
Xcopri
(cenobamate tablets)
|
| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-866-756-2844 |
Provider Phone: |
|
| Fax: |
1-877-436-4188 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patients must meet eligibility criteria for PAP, which includes: 1) US citizenship, 2) on-label diagnosis, 3) meets financial threshold, 4) patient is uninsured, functionally uninsured, or has a financial hardship.
|
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| 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
|
Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Either Provider and Patient
|
| Quantity in
Shipment: |
Up to 3-month supply |
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
Must re-enroll at end of calendar year
|
| Refill Policy: |
Program will contact patient to arrange |
| Other Information: |
|
|
|
Last Updated: 02/20/2024
www.RxAssist.org
|