What is Needed?

For financial assistance requests we need at least three pieces of information.

1. Necessary Information

The following information is the minimum information we will need to get the request started:

• The patient's name
• Phone number (or other contact method such as email)
• The drug

2. Helpful Information

The following information is not required, but can be very helpful in finding the best solution for the patient.

• Copay amount
• Deductible amount
• Insurance type (e.g. Medicare,