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Program Details
GILEAD SCIENCES
Cayston Access Program
Cayston
(aztreonam for inhalation solution)
|
| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-877-722-9786 |
Provider Phone: |
|
| Fax: |
1-877-550-1705 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patient eligibility determined on case-by-case basis.
Patients with Medicare Part D should contact the program for details.
Program offers co-pay assistance, reimbursement support, patient support, and patient assistance programs for eligible patients. |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Yes |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
Copy of front and back of insurnace cards, if applicable.
|
Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes |
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Patient
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
Patient contacts the pharmacy |
| Other Information: |
|
|
|
Last Updated: 01/29/2025
|
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
Form (Spanish)
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|
