Patient Assistance Foundation Enrollment
The Novartis Patient Assistance Foundation, Inc. (NPAF) is committed to providing access to Novartis medications for those most in need. If you are experiencing financial hardship and have limited or no prescription coverage, then you may be eligible to receive Novartis medications for free.
To be eligible for NPAF assistance, you must:
- Be a US resident
- Meet the income requirements below
- Have limited or no private or public prescription coverage
Household Size Annual Household Income Threshold
1 Person < $ 75,000
2 People < $100,000
3 People < $125,000
4 People < $150,000
>5 People Add $25,000 for each additional person
To enroll, select your medication from the list below and follow the directions provided.
Afinitor® (everolimus)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Afinitor Disperz® (everolimus suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Alomide® (lodoxamide tromethamine solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Arranon® (nelarabine)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Arzerra® (ofatumumab)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Azopt® (brinzolamide suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Betoptic S® (betaxolol hydrochloride suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Cipro® HC Otic (ciprofloxacin hydrochloride and hydrocortisone suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Ciprodex® (ciprofloxacin and dexamethasone)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Coartem® (artemether and lumefantrine)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Cosentyx® (secukinumab)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Cyclogyl® (cyclopentolate hydrochloride solution, USP)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Durezol® (difluprednate emulsion)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Emadine® (emedastine difumarate solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Entresto™ (sacubitril/valsartan)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Exjade® (deferasirox)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Extavia® (interferon beta-1b)
EXTAVIA Go Program
If you have questions or concerns about your treatment with EXTAVIA, the EXTAVIA Go Program is here for you. Whether you need specific answers about EXTAVIA from an EXTAVIA Go Program Navigator, injection training with EXTAVIA, or reimbursement information, the EXTAVIA Go Program is ready to give you the support you need. To learn more, call 1-866-EXTAVIA (398-2842), 8AM to 9PM Eastern Time, Monday through Friday.
Focalin® XR(dexmethylphenidate)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Gilenya® (fingolimod)
Gilenya patient assistance 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
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Gleevec® (imatinib mesylate)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Hycamtin® (topotecan) Capsules
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Hycamtin® (topotecan hydrochloride) For Injection
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Ilaris® (canakinumab)
Ilaris patient assistance 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
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Jadenu ® (deferasirox)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Jadenu® Sprinkle (deferasirox) granules
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Download the PAP Enrollment Application (English)
Download the PAP Enrollment Application (Español-Spanish)
Kisqali® (ribociclib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Kisqali® Femara® Co-Pack (ribociclib and letrozole) tablets
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Levoleucovorin Injection
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Maxidex® (dexamethasone suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Mekinist® (trametinib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Myfortic® (mycophenolic acid)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Neoral® (cyclosporine soft gelatin capsule, USP)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Nevanac® (nepafenac suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Omnitrope® Somatropin (rDNA origin)
OMNISOURCE – Omnitrope Support Program
OmniSource is a comprehensive patient support program dedicated to helping Omnitrope patients and their families. Specialists at OmniSource are specifically trained to address questions you might have about patient services, guide you through the insurance approval process, and provide helpful Omnitrope materials at your request. To learn more, call 877-456-6794, 8AM to 8PM Eastern Time, Monday through Friday.
Pataday® (olopatadine hydrochloride solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Pazeo® (olopatadine hydrochloride solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Promacta® (eltrombopag)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Reclast® (zoledronic acid)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Sandimmune® (cyclosporine)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
RYDAPT® (midostaurin)
Rydapt Patient Assistance Process
Call 1-800-282-7630 from 9 am to 8 pm ET, Monday through Friday, to begin the enrollment process
Sandostatin LAR® Depot (octreotide acetate)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Signifor® LAR (pasireotide)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Signifor® (Pasireotide)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Simbrinza® (brinzolamide/brimonidine tartrate suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Systane®
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tafinlar® (dabrafenib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tasigna® (nilotinib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tegretol® (carbamazepine)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tegretol-XR® (carbamazepine extended release)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tobradex® Ophthalmic Ointment (tobramycin and dexamethasone ointment)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tobradex® Ophthalmic Suspension (tobramycin and dexamethasone suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tobradex® ST (tobramycin / dexamethasone suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Travatan Z® (travoprost solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Triesence® (triamcinolone acetonide injectable suspension)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Trileptal® (oxcarbazepine)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Tykerb® (lapatinib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Vigamox® (moxifloxacin hydrochloride solution)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Votrient® (pazopanib)
Novartis Patient Assistance Foundation, Inc. (NPAF) Enrollment Process
- CALL 1-800-277-2254: You, your caregiver/family or doctor can call NPAF Monday through Friday, 8:00AM – 8:00PM ET to begin the process or to learn more
- COMPLETE THE APPLICATION: (Instructions are provided on the application)
- Download the application by clicking on the link below or call 1-800-277-2254
- Patients complete Page 2 and Health Care Professionals (HCP), page 3
- Be sure to sign and date the application
- Patients with insurance, please include a copy of the insurance card
- HCP portion MUST be faxed from the office
- Patient portion can be mailed or faxed
- The patient and HCP portion can be submitted together or separately
Zarxio™ (filgrastim-sndz)
Zarxio Patient Assistance 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