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Novartis Oncology Patient Assistance Program
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PO Box 52029
Phoenix, AZ 85072
Phone
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866-884-5906
Fax:
888-891-4924
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must be a US resident. |
Who Can Apply
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Doctors must ask for service request and have the application faxed or mailed to them. |
Required
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Doctors must complete a portion of the application, sign and attach a prescription. Patients must complete a portion of the application, sign and attach proof of income and any insurance information. |
Supply
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Not specified |
Ship To
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Doctor's office or patient's home |
Note
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Eligibility determined on a case-by-case basis.
Uninsured patients, call 1-866-884-5906
Patients with insurance, call 1-800-282-7630
This program also provides copay assistance up to $36,000 per year for Signifor and $9,600 per year for Sandostatin. Carcinoid tumor patients are now eligible. |
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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. |
Afinitor Disperz tablet |
Afinitor tablet |
Arranon Injection |
Arzerra injection |
Farydak capsule |
Gleevec tablet |
Hycamtin capsule |
Hycamtin Injection |
Jadenu |
Mekinist tablet |
Odomzo capsule |
Promacta |
Sandostatin LAR injection |
Signifor |
Signifor LAR |
Tafinlar capsule |
Tasigna capsule |
Tykerb |
Votrient tablet |
Zometa |
Zykadia capsule |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
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