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Celgene Patient Support
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Celgene Corporation
Summit, NJ 07901
Phone
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800-931-8691
Fax:
800-822-2496
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Eligibility
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This program is intended for patients that may have insurance, this includes Medicare Part D patients. Income requirements for this program have not been disclosed. Patient must be a US resident with prescription from US doctor. |
| Who Can Apply
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Anyone requesting assistance can call to request an application to me mailed, faxed or download it from the website. Application needs to be returned via fax or mail. |
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Required
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The doctor must complete section and sign the application. The patient must complete section, sign, attach proof of income and any insurance information. Patient and Doctor will be notified of acceptance within 24-48 hours. |
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Supply
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Up to 1 month supply. Patient or Doctor must contact company for refills. Company will contact patient about reapplying. |
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Ship To
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Doctor's office or patient's home. |
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Note
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Abraxane injectable suspension |
| Istodax injection |
| Pomalyst capsule |
| Revlimid |
| Thalomid (thalidomide) |
| Vidaza injectable; subcutaneous |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Celgene Patient Assistance Application |
(Requires Acrobat Reader) 
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Celgene Co-Pay Assistance Program
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Celgene Corporation
86 Morris Avenue
Summit, NJ 07901
Phone
:
800-931-8691
Fax:
(800) 822-2496
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Eligibility
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This program is intended for patients that have private insurance with a gross annual household income at or below $100,000 and are a US resident. Medicare Part D patients are not eligible for this program. |
| Who Can Apply
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Applicant must call for prescreening. Patient is then contacted if eligible after phone screening & will be contacted for any additional information. Patient and Doctor are notified within 24-48hrs of decision. |
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Required
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Supply
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Supply and Refill process not applicable at this time. Re-application process not specified. |
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Ship To
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Not specified. |
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Note
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Please visit www.celgenepatientsupport.com for more information. No online application available. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
|
| Abraxane injectable suspension |
| Pomalyst capsule |
| Revlimid |
| Thalomid (thalidomide) |
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Otezla SupportPlus Program
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,
Phone
:
844-468-3952
Fax:
855-850-2955
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Eligibility
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Insurance requirements are determined on a case by case basis, this includes Medicare part D patient's. Patient must reside permanently in the US or US territories. |
| Who Can Apply
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Provider must call for application & fax in the prescription. The patient responds to questions over the phone to verify eligibility. The patient will be given a decision over the phone during the screening process. No online application available. |
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Required
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Income requirements not disclosed at this time. Must provide a FDA-approved diagnosis. |
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Supply
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Supply varies by patient. Patient will be contacted by the company to arrange refills. Patient must re-enroll at the end of every calendar year. |
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Ship To
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Medication will be shipped to the patient's home within 1 week of receiving prescription. |
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Note
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*Patients are subject to audit and must provide financial documentation.
This program also provides co-pay, reimbursement assistance and adherence support. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Otezla tablet |
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