Amgen Safety Net Foundation Patient Application 2017 free printable template

PATIENT APPLICATION Amgen Safety Net Foundation is a nonprofit organization that helps to qualify patients access Amgen medicines at no cost. PATIENT INSTRUCTIONS To apply for support you must: 3

How to fill out Amgen Safety Net Foundation Patient Application

How to fill out Amgen Safety Net Foundation Patient Application

1. Obtain the Amgen Safety Net Foundation Patient Application form from the official website or through healthcare providers.
2. Fill out the patient's personal information, including full name, date of birth, and contact details.
3. Provide the patient's health insurance information, if applicable, including policy numbers and coverage details.
4. Describe the medical condition and the specific Amgen medication being requested.
5. Include information about the patient's income and financial situation, including any necessary supporting documentation.
6. Have the healthcare provider fill out the healthcare provider section, verifying the patient's medical condition and treatment plan.
7. Review the application for completeness and accuracy before submission.
8. Submit the application via the method specified (online, mail, or fax) and keep a copy for your records.

Who needs Amgen Safety Net Foundation Patient Application?

1. Patients who are prescribed Amgen medications and are uninsured or underinsured.
2. Individuals facing financial hardships that make it difficult to afford their prescribed Amgen treatments.
3. Healthcare providers who want to help their patients access necessary medications through financial assistance.

People Also Ask about

What is the Amgen assistance program for Enbrel?

Uninsured or unsure ENBREL® SupportPlus can put you in touch with the Amgen Safety Net Foundation—a nonprofit patient assistance program sponsored by Amgen that helps qualifying patients access Amgen medicines at no cost. To learn more, call ENBREL® SupportPlus at 1-888-4ENBREL (1-888-436-2735).

What are the hours of operation for Amgen Safety Net Foundation?

Amgen Safety Net Foundation is a nonprofit patient assistance program that helps qualifying patients access Amgen medicines at no cost. Questions? Contact us at 1-888-762-6436, Monday through Friday 8am to 8pm Eastern Time.

Does Amgen have a patient assistance program?

Through patient assistance programs, expanded access to investigational therapies, donations, and other programs, we've developed support programs for eligible patients around the world as they seek to obtain the medications they need.

How does Amgen Safety Net Foundation work?

THE PRIMARY FUNCTION OF AMGEN SAFETY NET FOUNDATION ("ASNF") IS TO PROVIDE POOR, INDIGENT AND FINANCIALLY DISTRESSED PATIENTS WITH ACCESS TO CERTAIN PRESCRIPTION DRUG THERAPIES THAT THEY COULD NOT OTHERWISE AFFORD. THE PRESCRIPTION DRUGS THAT ASNF DISTRIBUTES ARE PRODUCTS PRODUCED BY AMGEN INC. AND ITS AFFILIATES.

What is the Safety Net Foundation?

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.

What is Amgen Assistance Program?

PATIENT ASSISTANCE PROGRAMS: For those patients who need support in accessing our marketed medicines, Amgen has patient assistance programs to help clinically and financially eligible patients obtain the medicines they need.

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What is Amgen Safety Net Foundation Patient Application?

The Amgen Safety Net Foundation Patient Application is a form that individuals must complete to apply for assistance from the Amgen Safety Net Foundation, which provides access to Amgen’s medicines for eligible patients who are uninsured or underinsured.

Who is required to file Amgen Safety Net Foundation Patient Application?

Patients who are uninsured or underinsured and need help accessing Amgen medications are required to file the Amgen Safety Net Foundation Patient Application.

How to fill out Amgen Safety Net Foundation Patient Application?

To fill out the Amgen Safety Net Foundation Patient Application, you need to obtain the application form, provide required personal information, financial information, and details regarding your healthcare provider, and submit it as instructed on the form.

What is the purpose of Amgen Safety Net Foundation Patient Application?

The purpose of the Amgen Safety Net Foundation Patient Application is to determine eligibility for financial assistance and access to Amgen’s medications for patients who cannot afford them due to lack of insurance or high out-of-pocket costs.

What information must be reported on Amgen Safety Net Foundation Patient Application?

The Amgen Safety Net Foundation Patient Application must include information such as the patient's personal details, income, insurance status, type of medication needed, and information about the patient's healthcare provider.