Program Details
VIFOR PHARMA, INC.
VeltassaKonnect
Veltassa
(patiromer)
|
| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-844-870-7597 |
Provider Phone: |
|
| Fax: |
1-888-623-7092 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Program offers co-pay assistance, patient support, and patient assistance programs for eligible patients.
|
| |
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: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Patient
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
Not Published |
| Refill Policy: |
Not Published
|
| Other Information: |
The patient receives a free 15-day supply of VELTASSA directly - even before coverage is determined. If the benefit verification process takes longer than expected, a second 15-day supply of VELTASSA will be shipped to your patient at no cost. |
|
|
Last Updated: 03/08/2024
www.RxAssist.org
|