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Venofer Patient Assistance Program (for Free Standing Dialysis Clinics only)
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1901 Eastpoint Parkway
Louisville, KY 40223
Phone
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(877)694-7661
Fax:
(866)496-8638
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Eligibility
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This program is intended for Patients with no prescription coverage. Medicare partD not eligible. Income requirements not disclosed. Must be a US resident or legal entrant. |
| Who Can Apply
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Clinic must call for application to be faxed or download. Return application via fax or mail. Clinic will be notified in writing within 24-48hrs of decision. |
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Required
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Diagnosis/medical criteria required: End Stage Renal Disease (585.6) and be on dialysis. Doctor must complete and sign application. Patient must complete application sign and attach proof of income. |
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Supply
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Amount/supply varies. Refill process not applicable. Refill limit not specified. New application must be completed every 12 months. |
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Ship To
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Ships to clinic in 1-3 business days. |
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Note
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After PAP application approval the provider must return the Venofer product order form for replacement product.
Contact program for Spanish application. |
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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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| Venofer injection |
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