Patient Assistance Foundation Enrollment

The Novartis Patient Assistance Foundation, Inc. is committed to providing access to our medicines for those most in need. If you are experiencing financial hardship and have limited or no prescription coverage for your medicines, you may be eligible to receive your Novartis medicines at no cost.

To be eligible, you must:

  • Be a US resident
  • Meet the income requirements
  • Have limited or no prescription coverage

Patient Assistance Program:

  • To provide you with the best possible customer service, we recommend that you or your physician call our hotline. You will be asked a few qualifying questions to determine your eligibility for the program, and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
  • Please be advised that access to the medicines distributed through the Novartis Patient Assistance Foundation, Inc. is free of charge to all eligible patients. Novartis is not affiliated with any individual or organization that may charge patients a fee(s) to assist them in completing applications for our program. These individuals or organizations are acting independently of the Novartis Patient Assistance Foundation, Inc. and its affiliates and do not have Novartis' consent.
  • New Enrollment: To enroll in the Novartis PAP program select a product from the list below and follow the instructions provided:
Afinitor® (everolimus)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

 

Download the PAP Enrollment Application (English)

Download the PAP Enrollment Application (Español-Spanish)

Afinitor Disperz® (everolimus suspension)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

Download the PAP Enrollment Application (English)

Download the PAP Enrollment Application (Español-Spanish)

Alomide® (lodoxamide tromethamine solution)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

Download the PAP Enrollment Application (English)

Arranon® (nelarabine)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) complete page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

Download the PAP Enrollment Application (English)

Download the PAP Enrollment Application (Español-Spanish)

Arzerra® (ofatumumab)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) complete page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

Download the PAP Enrollment Application (English)

Download the PAP Enrollment Application (Español-Spanish)

Azopt® (brinzolamide suspension)

Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

  2. COMLPETE THE APPLICATION

    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

      1. Note: A signature and date are required from both the patient and HCP

      2. Note: Patients will need to provide income and insurance documentation (if applicable)

  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

    Download the PAP Enrollment Application (English)

    Betoptic S® (betaxolol hydrochloride suspension)

    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

    2. COMLPETE THE APPLICATION

      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

        1. Note: A signature and date are required from both the patient and HCP

        2. Note: Patients will need to provide income and insurance documentation (if applicable)

    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

      Download the PAP Enrollment Application (English) 

      Cipro® HC Otic (ciprofloxacin hydrochloride and hydrocortisone suspension)

      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

      2. COMLPETE THE APPLICATION

        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

          1. Note: A signature and date are required from both the patient and HCP

          2. Note: Patients will need to provide income and insurance documentation (if applicable)

      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

        Download the PAP Enrollment Application (English) 

        Ciprodex® (ciprofloxacin and dexamethasone)

        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

        2. COMLPETE THE APPLICATION

          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

            1. Note: A signature and date are required from both the patient and HCP

            2. Note: Patients will need to provide income and insurance documentation (if applicable)

        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

          Download the PAP Enrollment Application (English) 

          Coartem® (artemether and lumefantrine)

          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

          2. COMLPETE THE APPLICATION

            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

              1. Note: A signature and date are required from both the patient and HCP

              2. Note: Patients will need to provide income and insurance documentation (if applicable)

          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

          Download the PAP Enrollment Application (English)

          Cosentyx® (secukinumab)

          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

          2. COMLPETE THE APPLICATION

            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

              1. Note: A signature and date are required from both the patient and HCP

              2. Note: Patients will need to provide income and insurance documentation (if applicable)

          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

          Cyclogyl® (cyclopentolate hydrochloride solution, USP)

          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

          2. COMLPETE THE APPLICATION

            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

              1. Note: A signature and date are required from both the patient and HCP

              2. Note: Patients will need to provide income and insurance documentation (if applicable)

          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

            Download the PAP Enrollment Application (English) 

            Durezol® (difluprednate emulsion)

            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

            2. COMLPETE THE APPLICATION

              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                1. Note: A signature and date are required from both the patient and HCP

                2. Note: Patients will need to provide income and insurance documentation (if applicable)

            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

              Download the PAP Enrollment Application (English) 

              Emadine® (emedastine difumarate solution)

              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

              2. COMLPETE THE APPLICATION

                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                  1. Note: A signature and date are required from both the patient and HCP

                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                Download the PAP Enrollment Application (English) 

                Entresto™ (sacubitril/valsartan)

                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                2. COMLPETE THE APPLICATION

                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                    1. Note: A signature and date are required from both the patient and HCP

                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                Download the PAP Enrollment Application (English) 

                Exjade® (deferasirox)

                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                2. COMLPETE THE APPLICATION

                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                    1. Note: A signature and date are required from both the patient and HCP

                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                Download the PAP Enrollment Application (English)

                Download the PAP Enrollment Application (Español-Spanish)

                Extavia® (interferon beta-1b)

                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                2. COMLPETE THE APPLICATION

                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                    1. Note: A signature and date are required from both the patient and HCP

                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                  Download the PAP Enrollment Application (English) 

                  Farydak® (panobinostat)

                  Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                  2. COMLPETE THE APPLICATION

                    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                      1. Note: A signature and date are required from both the patient and HCP

                      2. Note: Patients will need to provide income and insurance documentation (if applicable)

                  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                  Download the PAP Enrollment Application (English)

                  Download the PAP Enrollment Application (Español-Spanish)

                  Flarex® (fluorometholone acetate suspension)

                  Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                  2. COMLPETE THE APPLICATION

                    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                      1. Note: A signature and date are required from both the patient and HCP

                      2. Note: Patients will need to provide income and insurance documentation (if applicable)

                  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Download the PAP Enrollment Application (English) 

                    Focalin® XR(dexmethylphenidate)

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Download the PAP Enrollment Application (English) 

                    Gilenya® (fingolimod)
                    PAP Enrollment Process

                    For patients who cannot afford the cost of Gilenya® treatment and lack insurance, the Patient/Physician may call the Gilenya® Go Program at 1800-445-3692.

                    Glatopa™ (glatiramer acetate)

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Download the PAP Enrollment Application (English) 

                    Gleevec® (imatinib mesylate)

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Hycamtin® (topotecan) Capsules

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Download the PAP Enrollment Application (English)

                    Download the PAP Enrollment Application (Español-Spanish)

                    Hycamtin® (topotecan hydrochloride) For Injection

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                    Download the PAP Enrollment Application (English)

                    Download the PAP Enrollment Application (Español-Spanish)

                    Ilaris® (canakinumab)
                    PAP Enrollment Process

                    For patients who cannot afford the cost of Ilaris® treatment and lack insurance, the Patient/Physician may call the Ilaris Patient Support Program at 1-866-972-8315.

                    Ilevro® (nepafenac suspension)

                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                    2. COMLPETE THE APPLICATION

                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                        1. Note: A signature and date are required from both the patient and HCP

                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                     

                      Download the PAP Enrollment Application (English) 

                      Jadenu ® (deferasirox)

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                      2. COMLPETE THE APPLICATION

                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                          1. Note: A signature and date are required from both the patient and HCP

                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                      Download the PAP Enrollment Application (English)

                      Download the PAP Enrollment Application (Español-Spanish)

                      Jadenu® Sprinkle (deferasirox) granules

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                      2. COMLPETE THE APPLICATION

                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                          1. Note: A signature and date are required from both the patient and HCP

                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                       

                      Kisqali® (ribociclib)

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254: You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 8:00AM-6:00PM ET to begin the process or learn more about the program. 
                      2. COMLPETE THE APPLICATION
                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254
                        2. Patients need to complete page 2 and Health Care Professionals (HCP) complete page 3.
                          1. Note: A signature and date are required from both the patient and HCP
                          2. Note: Patients will need to provide income and insurance documentation (if applicable)
                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you. Program eligibility is reviewed every year.  

                      Download the PAP Enrollment Application (English)

                      Kisqali® Femara® Co-Pack (ribociclib and letrozole) tablets

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                      2. COMLPETE THE APPLICATION

                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                          1. Note: A signature and date are required from both the patient and HCP

                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                      Levoleucovorin Injection

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                      2. COMLPETE THE APPLICATION

                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                          1. Note: A signature and date are required from both the patient and HCP

                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                      Download the PAP Enrollment Application (English)

                      Maxidex® (dexamethasone suspension)

                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                      2. COMLPETE THE APPLICATION

                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                          1. Note: A signature and date are required from both the patient and HCP

                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                        Download the PAP Enrollment Application (English)

                        Mekinist® (trametinib)

                        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                        2. COMLPETE THE APPLICATION

                          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                            1. Note: A signature and date are required from both the patient and HCP

                            2. Note: Patients will need to provide income and insurance documentation (if applicable)

                        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                        Download the PAP Enrollment Application (English)

                        Download the PAP Enrollment Application (Español-Spanish)

                        Myfortic® (mycophenolic acid)

                        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                        2. COMLPETE THE APPLICATION

                          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                            1. Note: A signature and date are required from both the patient and HCP

                            2. Note: Patients will need to provide income and insurance documentation (if applicable)

                        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                        Download the PAP Enrollment Application (English)

                        Neoral® (cyclosporine soft gelatin capsule, USP)

                        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                        2. COMLPETE THE APPLICATION

                          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                            1. Note: A signature and date are required from both the patient and HCP

                            2. Note: Patients will need to provide income and insurance documentation (if applicable)

                        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                        Download the PAP Enrollment Application (English)

                        Nevanac® (nepafenac suspension)

                        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                        2. COMLPETE THE APPLICATION

                          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                            1. Note: A signature and date are required from both the patient and HCP

                            2. Note: Patients will need to provide income and insurance documentation (if applicable)

                        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                           

                          Download the PAP Enrollment Application (English)

                          Omnitrope® Somatropin (rDNA origin)

                          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                          2. COMLPETE THE APPLICATION

                            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                              1. Note: A signature and date are required from both the patient and HCP

                              2. Note: Patients will need to provide income and insurance documentation (if applicable)

                          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                          Pataday® (olopatadine hydrochloride solution)

                          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                          2. COMLPETE THE APPLICATION

                            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                              1. Note: A signature and date are required from both the patient and HCP

                              2. Note: Patients will need to provide income and insurance documentation (if applicable)

                          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                             

                            Download the PAP Enrollment Application (English)

                            Pazeo® (olopatadine hydrochloride solution)

                            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                            2. COMLPETE THE APPLICATION

                              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                1. Note: A signature and date are required from both the patient and HCP

                                2. Note: Patients will need to provide income and insurance documentation (if applicable)

                            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                               

                              Download the PAP Enrollment Application (English)

                              Promacta® (eltrombopag)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                               

                              Download the PAP Enrollment Application (English)

                              Download the  PAP Enrollment Application (Español-Spanish)

                              Reclast® (zoledronic acid)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                              Download the PAP Enrollment Application (English)

                              Sandimmune® (cyclosporine)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                              Download the PAP Enrollment Application (English)

                              Sandostatin LAR® Depot (octreotide acetate)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                              Download the PAP Enrollment Application (English)

                              Download the PAP Enrollment Application (Español-Spanish)

                              Signifor® LAR (pasireotide)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                              Download the PAP Enrollment Application (English)

                              Download the PAP Enrollment Application (Español-Spanish)

                              Signifor® (Pasireotide)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                              Download the PAP Enrollment Application (English)

                              Download the PAP Enrollment Application (Español-Spanish)

                              Simbrinza® (brinzolamide/brimonidine tartrate suspension)

                              Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                              1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                              2. COMLPETE THE APPLICATION

                                1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                  1. Note: A signature and date are required from both the patient and HCP

                                  2. Note: Patients will need to provide income and insurance documentation (if applicable)

                              3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                 

                                Download the PAP Enrollment Application (English)

                                Systane®

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                 

                                Download the PAP Enrollment Application (English)

                                Tafinlar® (dabrafenib)

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                Download the PAP Enrollment Application (English)

                                Download the PAP Enrollment Application (Español-Spanish)

                                Tasigna® (nilotinib)

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                Download the PAP Enrollment Application (English)

                                Download the PAP Enrollment Application (Español-Spanish)

                                Tegretol® (carbamazepine)

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                Download the PAP Enrollment Application (English)

                                Tegretol-XR® (carbamazepine extended release)

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                Download the PAP Enrollment Application (English)

                                Tobradex® Ophthalmic Ointment (tobramycin and dexamethasone ointment)

                                Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                2. COMLPETE THE APPLICATION

                                  1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                  2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                    1. Note: A signature and date are required from both the patient and HCP

                                    2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                   

                                  Download the PAP Enrollment Application (English)

                                  Tobradex® Ophthalmic Suspension (tobramycin and dexamethasone suspension)

                                  Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                  1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                  2. COMLPETE THE APPLICATION

                                    1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                    2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                      1. Note: A signature and date are required from both the patient and HCP

                                      2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                  3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                     

                                    Download the PAP Enrollment Application (English)

                                    Tobradex® ST (tobramycin / dexamethasone suspension)

                                    Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                    1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                    2. COMLPETE THE APPLICATION

                                      1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                      2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                        1. Note: A signature and date are required from both the patient and HCP

                                        2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                    3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                     

                                      Download the PAP Enrollment Application (English)

                                      TOBI® (tobramycin inhalation solution USP)

                                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                      2. COMLPETE THE APPLICATION

                                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                          1. Note: A signature and date are required from both the patient and HCP

                                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                      Download the PAP Enrollment Application (English)

                                      TOBI®Podhaler® (tobramycin inhalation)

                                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                      2. COMLPETE THE APPLICATION

                                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                          1. Note: A signature and date are required from both the patient and HCP

                                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                      Download the PAP Enrollment Application (English)

                                      Travatan Z® (travoprost solution)

                                      Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                      1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                      2. COMLPETE THE APPLICATION

                                        1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                        2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                          1. Note: A signature and date are required from both the patient and HCP

                                          2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                      3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                       

                                        Download the PAP Enrollment Application (English)

                                        Triesence® (triamcinolone acetonide injectable suspension)

                                        Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                        1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                        2. COMLPETE THE APPLICATION

                                          1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                          2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                            1. Note: A signature and date are required from both the patient and HCP

                                            2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                        3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                         

                                          Download the PAP Enrollment Application (English)

                                          Trileptal® (oxcarbazepine)

                                          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                          2. COMLPETE THE APPLICATION

                                            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                              1. Note: A signature and date are required from both the patient and HCP

                                              2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                          Download the PAP Enrollment Application (English)

                                          Tykerb® (lapatinib)

                                          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                          2. COMLPETE THE APPLICATION

                                            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                              1. Note: A signature and date are required from both the patient and HCP

                                              2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                          Download the PAP Enrollment Application (English)

                                          Download the PAP Enrollment Application (Español-Spanish)

                                          Vigamox® (moxifloxacin hydrochloride solution)

                                          Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                          1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                          2. COMLPETE THE APPLICATION

                                            1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                            2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                              1. Note: A signature and date are required from both the patient and HCP

                                              2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                          3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                           

                                            Download the PAP Enrollment Application (English)

                                            Votrient® (pazopanib)

                                            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                            2. COMLPETE THE APPLICATION

                                              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                                1. Note: A signature and date are required from both the patient and HCP

                                                2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                             

                                            Download the PAP Enrollment Application (English)

                                            Download the PAP Enrollment Application (Español-Spanish)

                                            Zarxio™ (filgrastim-sndz)
                                            PAP Enrollment Process

                                            For patients who cannot afford the cost of Zarxio™ treatment and lack insurance, the Patient/Physician may call the Sandoz One Source 1-844-726-3691 .

                                            (9AM-8PM EST M-F)

                                            Fax 1-844-726-3695

                                            www.sandozonesource.com

                                            Zometa® (zoledronic acid for injection)

                                            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                            2. COMLPETE THE APPLICATION

                                              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                                1. Note: A signature and date are required from both the patient and HCP

                                                2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                            Download the PAP Enrollment Application (English)

                                            Download the PAP Enrollment Application (Español-Spanish)

                                            Zortress® (everolimus)

                                            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                            2. COMLPETE THE APPLICATION

                                              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                                1. Note: A signature and date are required from both the patient and HCP

                                                2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                            Download the PAP Enrollment Application (English)

                                            Zykadia™ (ceritinib)

                                            Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process

                                            1. CALL 1-800-277-2254:  You, your caregiver/family member or your physician can call the NPAF Monday through Friday, 9:00AM-6:00PM ET to begin the process or learn more about the program. 

                                            2. COMLPETE THE APPLICATION

                                              1. Download the application by clicking the link below or request an application by calling 1-800-277-2254

                                              2. Patients need to complete page 2 and Health Care Professionals (HCP) page 3.

                                                1. Note: A signature and date are required from both the patient and HCP

                                                2. Note: Patients will need to provide income and insurance documentation (if applicable)

                                            3. ELIGIBILITY PERIOD: Qualified individuals are eligible for up to one year of medication, or until a prescription drug benefit plan becomes available to you.  Program eligibility is reviewed every year. 

                                            Download the PAP Enrollment Application (English)

                                            Download the PAP Enrollment Application (Español-Spanish)

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