CONTACT
INFO |
|
Address: |
, |
Phone: |
1-877-422-8360 |
Provider Phone: |
|
Fax: |
1-240-696-8830 |
Website: |
Program Website |
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ELIGIBILITY
|
|
Eligibility
Info: |
Contact program for details.
Program temporarily provides Biogen products at no cost for individuals who meet certain financial eligibility criteria such as residency requirements, therapy status, income level, and insurance coverage.
Co-pay assistance is also available. |
|
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: |
Not Published
|
Physician
License #
Required: |
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Not Published
|
|
MEDICATION |
|
Receives: |
Not Published
|
Shipped To: |
Not Published
|
Quantity in
Shipment: |
Not Published
|
Delivery Time: |
Not Published
|
Re-application
Policy: |
Not Published |
Refill Policy: |
Not Published
|
Other Information: |
|
|