| |
Program Details
RADIUS HEALTH, INC.
Radius Assist Patient Assistance Program
Tymlos
(abaloparatide)
|
| CONTACT
INFO |
|
| Address: |
6000 Park Lane Drive
Pittsburgh, PA , PA 15275 |
| Phone: |
1-866-896-5674 |
Provider Phone: |
|
| Fax: |
1-800-910-4610 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patient should contact program for prescreening prior to completing application.
Patient must have no prescription coverage for needed medication.
Patients with Medicare Part D may be considered on an exceptions basis. Call program for details.
|
| Income at or below: |
Single |
|
300
% FPL |
| |
Couple |
|
300
% FPL |
| Federal Poverty Level Calculator |
 |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
No |
| US citizenship/residency specified:
|
Yes |
|
|
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: |
Up to 3-month supply |
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
Not Published |
| Refill Policy: |
Not Published
|
| Other Information: |
Approved patients may receive up to a 3-month supply
of medication at a time, for up to 12 months, subject to
continued eligibility and pursuant to a valid prescription. |
|
|
Last Updated: 04/18/2024
|
|
Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
|
|
