PAN: Inherited Retinal Disease

Not Funded

About

The PAN: Inherited Retinal Disease program offers significant assistance for patients requiring treatment for inherited retinal diseases with drugs such as Avastin, Lucentis, and Eylea. The program ensures swift eligibility determination and financial support, enabling patients to access necessary medication quickly and efficiently. With options for renewal and a broad coverage for off-label drugs, the PAN: Inherited Retinal Disease program facilitates ongoing support and care.

Insurance requirements: Commercially insured, Medicare / Medicaid

Enrollment Forms

Enrollment Form

Benefits

•$4300 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Please note that this fund may cover offlabel drugs

•Patients can either call (18663167263) or apply through selfservice patient portal

•Provided patient completes application on self service portal or over the phone, eligibility determination takes less than one minute

•Portal/representative will provide enrollment dates, the patient's PAN I.D. number and the available grant balance, allowing for medications to be dispensed

•Patients will also receive approval letter and plastic pharmacy card within one week (provider will also receive letter)

•Assistance begins on approval date and continues for 12 months

•During initial eligibility period, eligible expenses incurred up to 90 days prior to approval date may also be submitted for reimbursement

•All eligible expenses must be submitted within 120 days of the eligibility end date

•Payment can be made to the patient, physician, pharmacy or health care provider

•Patients are eligible for renewal at the end of their eligibility period if funds are available

•Foundation will send a renewal application automatically if the program is accepting renewal patients

•Patient may apply for a second grant during their eligibility period subject to availability of funding

•Diagnosis Codes: ICD10: H31.21, H35.3110, H35.3111, H35.3112, H35.3113, H35.3114, H35.3120, H35.3121, H35.3122, H35.3123, H35.3124, H35.3130, H35.3131, H35.3132, H35.3133, H35.3134, H35.3190, H35.3191, H35.3192, H35.3193, H35.3194, H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233, H35.3290, H35.3291, H35.3292, H35.3293, H35.351, H35.352, H35.353, H35.359, H35.361, H35.362, H35.363, H35.369, H35.371, H35.372, H35.373, H35.379, H35.50, H35.51, H35.52, H35.53 H35.54, H35.89, H44.20, H44.21, H44.22, H44.23, H44.2A1, H44.2A2, H44.2A3, H44.2A9, H47.211, H47.212, H47.213, H47.219, H47.22

Enrollment Forms

Enrollment Form