Take a look at some helpful information we’ve compiled for providers.
To view processing and billing information, download our print-friendly provider guide.Download the Guide
Applying for a Patient
Would you like to apply on behalf of a patient?
Providers, case managers, caregivers, patients, and patient advocates can apply on behalf of a patient. Applications can be received online or by telephone, fax, or mail. In doing so, it is necessary to obtain the following information:
- Basic Patient Info, including:
- Phone number
- Date of birth
- Patient insurance and prescription info
- Patient income information (household size and household income).
Healthcare / Infusion Providers
The Assistance Fund accepts Explanation of Benefits. For healthcare providers who are administering a prescription medication at their site, payments are facilitated through a Visa E-Card. To establish an E-Card or set up a payment for your patient, please contact a Patient Advocate at (855) 845-3663. Patient Advocates are available Monday–Friday, 9am–6pm EST, excluding holidays.
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