RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

ALEXION PHARMACEUTICALS
OneSource Patient Support Program

Soliris (eculizumab)
 
CONTACT INFO
Address:
,
Phone: 1-888-765-4747 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Eligibility determined on case-by-case basis.
  • Patient with Medicare Part D are not eligible.
  • This program also provides co-pay assistance.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: Not Published
    Physician License #
    Required:
    Not Published
    Prescriber Signature
    Allowed:
    Not Published
    Application may be
    faxed:
    Not Published
    Eligibility determination
    letter sent:
    Not Published
    MEDICATION
    Receives: Not Published
    Shipped To: Not Published
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Not Published
    Refill Policy: Not Published
    Other Information:

    Last Updated: 02/13/2024

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2024, RxVantage, all rights reserved.