Safety Net® Foundation
Amgen
Contact Information
Safety Net Foundation
P.O. Box 18769
Louisville, KY 40261-7821
Phone: 1-888-762-6436 (Monday through Friday, 9:00 a.m. to 8:00 p.m. Eastern Time)
Fax: 1-866-549-7239
Safety Net Foundation
P.O. Box 18769
Louisville, KY 40261-7821
Phone: 1-888-762-6436 (Monday through Friday, 9:00 a.m. to 8:00 p.m. Eastern Time)
Fax: 1-866-549-7239
How to Apply:
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.
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.
- Website to download forms or schedule a refill online: www.safetynetfoundation.com
Eligibility:
Safety Net Foundation is designed to assist those patients who are uninsured and with limited or no financial resources. Eligibility is based on US residency, insurance status and income criteria. To enroll a patient, providers and patients should visit our website at www.safetynetfoundation.com or call us at (888) 762-6436.
Safety Net Foundation is designed to assist those patients who are uninsured and with limited or no financial resources. Eligibility is based on US residency, insurance status and income criteria. To enroll a patient, providers and patients should visit our website at www.safetynetfoundation.com or call us at (888) 762-6436.
- Must have lived in the US or its territories for 6 months or longer.
Other Information:
For Nplate™ Prolia™ and Sensipar® providers or patients should submit a Patient Enrollment Application for each patient to be considered for Foundation eligibility. Completion of the application form requires the patient's signature. For Aranesp®, EPOGEN®, Neulasta®,Nplate®, Vectibix®, and NEUPOGEN®: we recommend that providers call The Safety Net Foundation to pre-assess patients prior to submitting a form. Foundation staff can complete some portions of the application and send to the provider or patient for completion and signatures. The Safety Net Foundation reserves the right to approve or deny any Safety Net Foundation application or to modify or discontinue the program with respect to any patient or provider, or in its entirety, at any time. The Safety Net Foundation reserves the right to make an independent determination of eligibility in all cases
For Nplate™ Prolia™ and Sensipar® providers or patients should submit a Patient Enrollment Application for each patient to be considered for Foundation eligibility. Completion of the application form requires the patient's signature. For Aranesp®, EPOGEN®, Neulasta®,Nplate®, Vectibix®, and NEUPOGEN®: we recommend that providers call The Safety Net Foundation to pre-assess patients prior to submitting a form. Foundation staff can complete some portions of the application and send to the provider or patient for completion and signatures. The Safety Net Foundation reserves the right to approve or deny any Safety Net Foundation application or to modify or discontinue the program with respect to any patient or provider, or in its entirety, at any time. The Safety Net Foundation reserves the right to make an independent determination of eligibility in all cases
Product(s) covered by program:
- Aranesp®
- Enbrel®
- EPOGEN®
- Neulasta®
- Neupogen®
- Nplate®
- Prolia™
- Sensipar®
- Vectibix®
