HealthWell: Amyotrophic Lateral Sclerosis
Funded
About
The HealthWell: Amyotrophic Lateral Sclerosis program provides critical financial support to patients dealing with Amyotrophic Lateral Sclerosis by helping cover the costs of essential drugs, including Botox, Recombinate, Increlex, Rilutek, Radicava IV, Tiglutik, Radicava ORS, and Qalsody. HealthWell ensures that eligible patients in the United States receive the benefits of this program to alleviate their financial burden, ensuring access to necessary medications.
Insurance requirements: Commercially insured, Medicare / Medicaid
Enrollment Forms
Enrollment Form
Benefits
•$15000 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 copay/premium fund may cover offlabel drugs
•No Minimum copay reimbursement amount and No Minimum premium reimbursement amount
•Eligible patients can complete the application process online or by phone
•Patients must submit the Diagnosis Verification form (completed & signed by provider), copy of insurance cards, and prescription cards through the portal or by fax (18002827692) within 30 days of application
•Approved patients will receive a letter detailing assistance. They can access their grant by using their ‘HealthWell Foundation Copayment Assistance Card’, by asking their provider’s office or pharmacy to direct bill with HealthWell, or by paying up front and submitting claim to HealthWell for direct reimbursement
•Patients will have one full year to use the grant before needing to reenroll (Grants are given on a firstcome, firstserved basis)
•For grants to remain active, the first complete reimbursement request must be received within 90 days of approval date, and continue at least every 90 days
•Grants with no activity for over 90 days will be considered inactive and closed
•Patients who are approved for a grant but do not use a portion of their grant money may not be able to reenroll
Enrollment Forms
Enrollment Form