Financial Assistance Banner

Financial Assistance

Daiichi Sankyo Access Central offers financial assistance for eligible patients prescribed Injectafer. Call 1-866-4-DSI-NOW to learn how to help your patients access Injectafer.

fFinancial Assistance Tab

INJECTAFER Patient Assistance Program Tab Content

Help for uninsured patients with financial need

If your patients are uninsured and need help paying for their Injectafer treatment, they may be eligible for the Patient Assistance Program (PAP). The Injectafer PAP is a product replacement program.*

Eligibility

To qualify, a patient must:

  • Meet established income limits
  • Lack health insurance completely
  • Be a US citizen, a legal entrant in the United States, or a permanent resident
How to apply for the Injectafer Patient Assistance Program

Enroll your patient in the program in 1 of 2 ways:

  • Download the Patient Enrollment Form and fax it to 1-888-354-4856 (preferred method for fastest support) OR
  • Call 1-866-4-DSI-NOW
Important timing notice
  • Submit the Patient Enrollment Form before the patient’s infusion and confirm enrollment
Patient Enrollment Form
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 to 1-888-354-4856 after the patient's infusion.

Product Request Form
  • Plan at least 8 days in advance. In most cases, if you submit the Product Request Form by EOD Wednesday, the product will be shipped overnight on the following Wednesday. (Holidays and weather may cause delays.)
*The company reserves the right to modify or cancel the program immediately with respect to any patient, or in its entirety, at any time.

The completion and submission of coverage- or reimbursement-related documentation are 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.