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For New Patients: Apply through Novartis Patient Support at 1 866 433 8000 or visit the website at www.scemblix.com. Prescribers need to complete Scemblix Start Form found on www.scemblix-hcp.com and send the form to Novartis Patient Support, fax number: 1 800 368 5564. For Reenrolling Patients: Download the NPAF application form
providers (“Novartis”) and the Novartis Patient Assistance Foundation, Inc., and its service providers (“NPAF”) so they can provide the following support services (the “Services”): • Help coordinate insurance coverage for, access to, and receipt of my medication.
If you have limited or no insurance coverage, the Novartis Patient Assistance Foundation, Inc. provides medicines at no cost to eligible US patients who are experiencing financial hardship.
Thank you for your interest in the Novartis Patient Assistance Foundation, Inc. To be eligible, a patient must: • Be a U.S. resident • Meet the income requirements • Have limited or no prescription coverage Novartis Patient Assistance Foundation, Inc. The following products are available: AFINITOR ® (everolimus) tablets
What to do: Step 1 – Complete and sign Patient Section (page 2) Step 2 – Attach copies of all required financial documentation Step 3 – Your Doctor completes and signs Prescription Section (page 3) Step 4 – Mail or fax form with documentation.
Call NPAF at 1-800-277-2254 1-800-277-2254.FAX: 1-855-817-2711 or US Mail: PO Box 2529 Columbus, OH 43216
eligible for the Novartis Patient Assistance Foundation Program (“NPAFP”) patients must be a U.S. resident, meet the income requirements, and must not have prescription drug coverage. Please complete the following steps to apply for the NPAFP. 1.) Complete all patient and physician sections of the attached application. 2.)
The Novartis Patient Assistance Foundation (NPAF) is an independent, 501(c)(3) non-profit, non-commercial entity. Patients who cannot afford the cost of their Novartis medication may be eligible to receive them from NPAF at no cost. Visit www.PAP.Novartis.com or call 1-800-277-2254 to learn more.
The Novartis Patient Assistance Foundation Program provides assistance to patients experiencing financial hardship who have no third-party insurance coverage for their medicines. Patient must be a U.S. Resident.
Check www.PAP.Novartis.com to see if you may be eligible for the program. Check your application and make sure all the blanks are filled in or mark N/A. Include copies of the front and back of ALL your insurance cards.