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Program Details
SK LIFE SCIENCE, INC.
SK Life Science Navigator
Xcopri
(cenobamate tablets)
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| CONTACT
INFO |
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| Address: |
, |
| Phone: |
1-866-756-2844 |
Provider Phone: |
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| Fax: |
1-877-436-4188 |
Website: |
Program Website |
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| ELIGIBILITY
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| Eligibility
Info: |
Patients must meet eligibility criteria for PAP, which includes: 1) US citizenship, 2) on-label diagnosis, 3) meets financial threshold, 4) patient is uninsured, functionally uninsured, or has a financial hardship.
|
| 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 |
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| Attachments
Required: |
Financial
|
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 |
|
| Receives: |
Medication
|
| Shipped To: |
Either Provider and Patient
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| Quantity in
Shipment: |
Up to 3-month supply |
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
Must re-enroll at end of calendar year
|
| Refill Policy: |
Program will contact patient to arrange |
| Other Information: |
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Last Updated: 02/20/2024
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SK Life Navigator Enrollment Form