NapoCares Patient Assistance Program

Funded

About

The NapoCares Patient Assistance Program assists eligible patients by providing them access to the drug Mytesi at no cost. This program greatly benefits those who are uninsured or without insurance coverage options, allowing them access to an important medication. The NapoCares Patient Assistance Program ensures affordability and accessibility by also requiring proof of income and a valid prescription. By addressing these critical needs, the NapoCares Patient Assistance Program makes Mytesi accessible for those who qualify.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

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

•Provides eligible patients access to Mytesi at no cost

•Patients can mail or fax completed application form to: NapoCares Patient Assistance Program Application, P.O. BOX 7613 OVERLAND PARK, KS 66207, Fax: 4159639830

•Patient must complete and sign Authorization for Use or Disclosure of Health Information Form and Patient Section of the application form

•Physician must complete Physician's Section of the application form

•Proof of income must also be submitted (e.g. current pay stubs, last year's Tax Return, W2 or 1099 forms, etc.)

•For assistance, call (888) 527NAPO (6276) MondayFriday, 8am–8pm EST

Enrollment Forms

Enrollment Form