Compassionate Care Discount Program for TFC Patients
Serono Compassionate Care is available to eligible patients who may not otherwise be able to afford fertility medication. The program offers certain EMD Serono fertility medications at deep discounts, including Gonal-f® RFF Pen (follitropin alfa injection) to patients who meet the following eligibility criteria:
- No insurance coverage for fertility medication
- Currently undergoing fertility treatment with a TFC fertility specialist
- US citizen or permanent resident
- Qualifying annual household gross income based on a standard set of parameters
- Qualifying income is assessed according to a standard set of parameters including the Federal poverty guidelines, which take into account the number of persons in household and state of residence.
If you meet the above criteria please you will need to complete the Patient Enrollment Form and Authorization forms. Completed forms can be mailed or faxed to:
Compassionate Care Program
6501 Weston Parkway, Suite 370
Cary, NC 27513
Monday-Friday: 9 am–5:30 pm EST
For more information on the enrollment process please visit Fertility Lifelines
Applications will be confidentially evaluated on an individual basis and will not be reviewed until all supporting income information is received, including most recent 1040 tax return, last two pay stubs, and a copy of the front and back of the patient’s insurance card. If eligibility criteria are met, a product request form will be sent to the physician as listed on the enclosed patient application. Once the physician returns the form and the patient’s application is approved, the request will be processed and product will be shipped directly to the physician’s office.
If you have any questions please contact our Authorizations Department at (512)451-0149 x7438 or 7482