•Please note the following:
•1. This fund may cover offlabel drugs
•2. This fund is for premium assistance only
•Provides assistance for the patient’s portion of the premium associated with their coverage
•This may involve an individual or family plan for those patients approved for assistance
•Once approved for program, patient will receive assistance for their full 12 months of eligibility regardless of their ongoing treatments
•Patient will not qualify for an additional year of assistance if they are not receiving treatments of a covered therapy
•Patients approved for the program can either make the payments and be reimbursed by PAN or, depending on the employer and or payor situation, PAN can make the premium payments directly to the payor
•Patient may receive grant benefits from both premium and copay programs if they meet eligibility criteria for each program
•Patients will not need to provide income documentation as part of the eligibility process, however a small number of randomly selected patients will need to provide income documentation as part of PAN's auditing process
•Patients can either call (18663167263) or apply through selfservice patient portal
•Diagnosis Codes: ICD10: D66, D67, D68.1, D68.311, D68.4