Program Details
DECIPHERA PHARMACEUTICALS
Deciphera AccessPoint
Qinlock
(ripretinib tablet)
|
| CONTACT
INFO |
|
| Address: |
PO Box 5490
Louisville, KY 40255 |
| Phone: |
1-833-432-2237 |
Provider Phone: |
|
| Fax: |
1-833-327-4329 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Deciphera AccessPoint has different types of financial assistance programs, such as co-pay assistance, foundation referrals and financial assistance, to help you with out-of-pocket costs.
For patient assistance, patient must not have insurance or does not have coverage for medication needed. |
| |
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: |
DEA
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Provider
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Patient
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
Not Published
|
| Other Information: |
|
|
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Last Updated: 05/14/2024
www.RxAssist.org
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