Program Details
SANOFI GENZYME
Caprelsa Patient Assistance Program
Caprelsa
(vandetanib)
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CONTACT
INFO |
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Address: |
, |
Phone: |
1-800-367-4999 |
Provider Phone: |
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Fax: |
1-888-275-8593 |
Website: |
Program Website |
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ELIGIBILITY
|
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Eligibility
Info: |
Patient must be uninsured or underinsured.
Patients with Medicare Part D may be eligible.
Program offers co-payment assistance, reimbursement support, and patient assistance programs for eligible patients.
|
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Couple |
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% 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 |
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APPLICATION |
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Attachments
Required: |
Copy of Insurance denial, if applicable.
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Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
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MEDICATION |
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Receives: |
Varies
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Shipped To: |
Patient
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Quantity in
Shipment: |
Not Published
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Delivery Time: |
Not Published
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Re-application
Policy: |
Not Published |
Refill Policy: |
Patient must contact program. |
Other Information: |
Prescribing Physician, Healthcare Facilites, Pharmacies and Patients must enroll into the Risk Evaluation and Mitigation Strategy (REMS) Program prior to initiating the patient on treatment with Caprelsa. |
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Last Updated: 02/26/2024
www.RxAssist.org
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