Program Details
SAGE THERAPEUTICS, INC.
Sage Central Patient Support
Zulresso
(brexanolone injection)
|
| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-844-472-4379 |
Provider Phone: |
|
| Fax: |
1-833-564-7243 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patient must be uninsured or underinsured.
Patients enrolled in Medicare, Medicaid or any other federal or state funded health plan may participate in the program if they receive the free product outside of their government-funded benefits. |
| Income at or below: |
Single |
|
500
% FPL |
| |
Couple |
|
500
% 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: |
Not Published
|
Physician
License #
Required: |
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Provider
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
Not Published |
| Refill Policy: |
Not Published
|
| Other Information: |
|
|
|
Last Updated: 02/20/2024
www.RxAssist.org
|