Program Details
Mirati Therapeutics, Inc.
Mirati & Me
Krazati
(adagrasib)
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CONTACT
INFO |
|
Address: |
, |
Phone: |
1-844-647-2842 |
Provider Phone: |
|
Fax: |
1-844-647-2844 |
Website: |
Program Website |
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ELIGIBILITY
|
|
Eligibility
Info: |
Patient must be uninsured or underinsured for patient assistance program.
Co-pay assistance is also available to eligible patients. |
Income at or below: |
Single |
|
% FPL |
|
Couple |
150,000 |
% FPL |
Income at or below: |
Not
Published |
Other Income
Requirements: |
$150,000 for household size of 2 people; $25,000 per additional person in household. |
Medical expenses
can be deducted from reported income: |
Not
Published |
Social security requested on form: |
Not
Published |
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: |
Not Published
|
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MEDICATION |
|
Receives: |
Medication
|
Shipped To: |
Not Published
|
Quantity in
Shipment: |
Not Published
|
Delivery Time: |
Not Published
|
Re-application
Policy: |
New application every 12 months
New financial information every 12 months
|
Refill Policy: |
Not Published
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Other Information: |
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Last Updated: 12/16/2022
www.RxAssist.org
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