Program Details
NEUROCRINE BIOSCIENCES, INC.
Inbrace Support Program - Ingrezza
Ingrezza
(valbenazine)
|
| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-844-647-3992 |
Provider Phone: |
|
| Fax: |
1-844-394-7155 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patients must not have prescription drug coverage for INGREZZA and lack the financial resources to pay for their medicine.
Each applicant will be assessed for individual program eligibility.
Program offers co-pay assistance, reimbursement 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: |
Yes |
| US citizenship/residency specified:
|
Not
Published |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
|
Physician
License #
Required: |
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Patient
|
| Quantity in
Shipment: |
Varies |
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
Not Published
|
| Other Information: |
|
|
|
Last Updated: 04/18/2024
www.RxAssist.org
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