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Patient Assistance Solutions Program for Letairis
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po bOX 13185
La Jolla, CA 92039
Phone
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(866)664-5327
Fax:
(888)856-7991
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Eligibility
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This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Income based on FPL. Must be a US resident. |
| Who Can Apply
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Call to have application faxed, mailed or download from website. Application must be returned from Doctor's office via fax or mail. Patient and Doctor notified in writing in 3-5 business days. |
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Required
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Medically appropriate condition/diagnosis required. Doctor and patient must complete and sign application. |
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Supply
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Up to 30 day supply. Patient contacts pharmacy for refills. No refill limit. Re-application process determined case by case. |
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Ship To
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Ship to Patient's home, unless otherwise noted with 2 business days. |
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Note
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The prescriber must also be enrolled in the program using Letaris Physician Form.
Female patients must first be enrolled in LEAP (Letairis Education and Access Program) in order to access this program.
This program also provides copay assistance. |
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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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| Letairis tablet |
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