Immunex Patient Assistance Program
Immunex Corporation
Contact Information
490 2nd Street
Suite 201
San Francisco, CA 94107
1-(800) 321-4669 (phone)
1-(800) 944-3184 (fax)
490 2nd Street
Suite 201
San Francisco, CA 94107
1-(800) 321-4669 (phone)
1-(800) 944-3184 (fax)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
- Click here to visit the program's web site.
Eligibility:
"The patient must be a US Citizen or legal US resident (including US territories), have no insurance or be capped out on insurance or be denied coverage for the drug. The patient must also have financial need."
"The patient must be a US Citizen or legal US resident (including US territories), have no insurance or be capped out on insurance or be denied coverage for the drug. The patient must also have financial need."
Other Information:
"The provider must call the hotline before starting the patient on therapy. They will not enroll patients retroactively. They will do an initial screening and fax the prescribing physician a patient-specific application packet that cannot be copied.The completed application may be faxed to the company. The Hotline will notify the physician regarding eligibility within 24 hours of receipt. (Incomplete applications will be returned, causing a delay.)"
"The provider must call the hotline before starting the patient on therapy. They will not enroll patients retroactively. They will do an initial screening and fax the prescribing physician a patient-specific application packet that cannot be copied.The completed application may be faxed to the company. The Hotline will notify the physician regarding eligibility within 24 hours of receipt. (Incomplete applications will be returned, causing a delay.)"
