Financial Assistance Banner

Financial Assistance

Daiichi Sankyo Access Central offers financial assistance for eligible patients prescribed INJECTAFER. Talk to an Access Central Coordinator about how to help your patients access INJECTAFER.

Financial Assistance Tab

INJECTAFER Patient Assistance Program Tab Content

Options for uninsured patients prescribed INJECTAFER

Daiichi Sankyo Access Central can assist patients without insurance coverage who have been prescribed INJECTAFER. You can screen individuals without health insurance who are ineligible for public assistance for enrollment. If a patient is eligible for the INJECTAFER Patient Assistance Program, Daiichi Sankyo, Inc., will replace the INJECTAFER provided free of charge while the patient is enrolled in the program. Daiichi Sankyo, Inc., reserves the right to modify or cancel the program immediately with respect to any patient, or in its entirety, at any time.

Eligibility

To be eligible for coverage support, patients must completely lack health insurance and be ineligible for public insurance or financing. The patient must be a US citizen, legal entrant in the United States, or permanent resident. Proof of citizenship or legal residency may also be required. Patients must also meet income and other criteria as established by Daiichi Sankyo, Inc.

How to apply for the INJECTAFER Patient Assistance Program

Providers (hospitals, physicians, or infusion centers) may apply to the program on behalf of their patients. Call an Access Central Coordinator to get started, or you can download the INJECTAFER Patient Assistance Program Enrollment Application and fax it back to us (1-888-354-4856).

Enrollment Application

Product Replacement

If you have a patient enrolled in the INJECTAFER Patient Assistance Program and are in need of product replacement for your practice, please fill out the Product Request Form and fax it back to us (1-888-354-4856).

Product Request Form

The completion and submission of coverage- or reimbursement-related documentation is the responsibility of the patient and healthcare provider. Daiichi Sankyo, Inc., makes no representation or guarantee concerning coverage or reimbursement for any service or item. A completed form includes signatures from both the physician and the patient. Before submitting, please ensure all required information is provided.