Patient eligibility is based both on the patient and healthcare provider’s responses to questions in the Program Application. The following general criteria apply:

• Patient must submit a complete application
• Healthcare provider must complete an application and provide a prescription to the Specialty Pharmacy
• Patient must be a legal resident of the United States
• Patient may not reside in a hospital, nursing home, correctional facility or court appointed program or facility
• Patient cannot have government health insurance or private health insurance with a prescription benefit
• Patient cannot participate in a State Pharmacy Assistance Program
• Patient must meet annual gross income requirements to participate in the reduced cost or no cost

All products provided through this program must be prescribed and intended to be used on-label.