| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-800-456-2255 |
Provider Phone: |
|
| Fax: |
|
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Call program for pre-screening.
For patients who are uninsured or underinsured, the program will research possible assistance programs for you.
For Government insured patients, program will check to see if patient is eligible for alternative government insurance programs.
Patients with commercial insurance may be eligible for the Biogen Copay Program.
|
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| 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: |
Not Published
|
Physician
License #
Required: |
Not Published
|
Prescriber
Signature
Allowed: |
Not Published
|
Application
may be
faxed: |
Not Published
|
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Not Published
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
Not Published |
| Refill Policy: |
Not Published
|
| Other Information: |
|
|