Sun Pharma Cares
HAS YOUR DOCTOR RECOMMENDED IMATINIB MESYLATE?
Sun Pharma is pleased to offer financial assistance for eligible patients through the copay IMATINIB Savings Card OR the Sun Pharma Patient Assistance Program (PAP)
IMATINIB Savings Card - Copay Program:
Do you have commercial health insurance?
You may be eligible for the IMATINIB Savings Card!
Review the participation Terms and Conditions and highlighted guidelines below.
Click Submit to agree to the Terms and Conditions
Get a printable Imatinib Savings Card with your personal I.D. number.
CLICK HERE To Review the IMATINIB Savings Card – Terms and Conditions:
By participating in the IMATINIB Savings Card program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
The Savings Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare or other federal or state healthcare programs including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
This Savings Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs, which reimburse you for the entire cost of your prescription drugs.
You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
Eligible patients may pay a minimum of $10 per prescription fill (30 day supply). By using the card eligible patients will receive a savings of up to $700 per fill off their co-pay or out-of-pocket costs. Card use restricted to one 30 day supply fill or refill per month.
The Savings Card cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
The Savings Card will be accepted only at participating pharmacies.
The Savings Card is not health insurance.
The offer is good only in the U.S. and Puerto Rico.
The Savings Card is limited to one patient during this offer period and is not transferable.
Sun Pharma reserves the right to rescind, revoke, or amend this offer without notice at any time.
There are no membership fees for this savings program.
This Savings Card program expires on 10/31/2016.
I understand this offer is not valid for cash paying patients or for patients whose prescriptions are paid
for in whole or in part by either Medicaid, Medicare or any other Federal or State funded program.
I verify I have commercial health insurance and agree to the Terms and Conditions.
By clicking Submit I validate that I agree to the Terms and Conditions and I meet the eligibility requirements of the Imatinib Savings Card Program.
Patient Assistance Program (PAP):
You may be eligible for additional prescription savings through the Sun Pharma
Patient Assistance Program (PAP).
The Sun Pharma Imatinib Patient Assistance Program (PAP) is offered to allow qualified patients to obtain free medication. It is not a government program or an insurance plan.
WHO SHOULD APPLY:
Patient may qualify for the Program if:
- The patient does not have existing drug coverage for the prescribed product under any prescription drug benefit, including private insurance, Medicare, Medicaid, or other government insurance programs or the Patient is in the 90-Day Waiting Period for Medicare coverage.
- The patient is a U.S. Resident, Green Card or Work Visa holder.
- The patient has an income at or below 500% of the Federal Poverty Level (FPL)
or the patient has experienced a recent financial challenge due to circumstances such as changes in household income, loss of employment, changes in marital status or changes in household number: (Supporting documentation explaining changes in circumstance and new income will be required).
WHAT TO EXPECT IF I’M APPROVED:
- If a patient qualifies, they may receive free medication monthly through July 2016 as long as they continue to meet the program requirements.
- Medication will be sent directly to the patient’s home or an alternate shipping address of choice. All packages require a signature at the time of delivery.
- Medication is sent in a 30 day supply.
HOW TO APPLY:
- Download the Sun Pharma Patient Assistance Program Application.
- Complete the application and follow the submission instructions found on the application.
- If you have questions or need additional assistance please contact our
Patient Care Specialist toll free at 844-502-5950.
Notice: Sun Pharma reserves the right to change, rescind, or revoke this program at any time.
Report Suspect or Adverse Side Effects:
- To report SUSPECTED ADVERSE REACTIONS, contact Ranbaxy Pharmaceuticals Inc. at 1-800-406-7984 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.