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Hypercholesterolemia

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Program Status

Fully Allocated - We are no longer accepting or processing applications for new or renewal patients.

 

 

 

 

 

 

Assistance Amount

$3,500 per year. Patients may apply for a second grant during their eligibility period subject to availability of funding.

Please be advised that a minimum claim of $25 is required for PAN to process the claim. You may combine multiple prescriptions to meet the minimum claim threshold.

Eligibility Criteria

  1. The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
  2. The patient must have Medicare health insurance that covers his or her qualifying medication or product. 
  3. The patient’s medication or product must be listed on PAN’s list of covered medications.
  4. The patient’s income must fall at or below 400% of the Federal Poverty Level.
  5. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
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See the list of medications covered in this program
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  • Advicor (niacin/lovastatin)
  • Altoprev (lovastatin)
  • Amlodipine-Atorvastatin (amlodipine besylate/atorvastatin calcium)
  • Antara (fenofibrate,micronized)
  • Atorvastatin Calcium (atorvastatin calcium)
  • Caduet (amlodipine besylate/atorvastatin calcium)
  • Cholestyramine (cholestyramine (with sugar))
  • Cholestyramine Light (cholestyramine/aspartame)
  • Colestid (colestipol hcl)
  • Colestipol Hcl (colestipol hcl)
  • Crestor (rosuvastatin calcium)
  • Ezetimibe (ezetimibe)
  • Fenofibrate (fenofibrate)
  • Fenofibrate (fenofibrate nanocrystallized)
  • Fenofibrate (fenofibrate,micronized)
  • Fenofibric Acid (fenofibric acid)
  • Fenofibric Acid (fenofibric acid (choline))
  • Fenoglide (fenofibrate)
  • Fibricor (fenofibric acid)
  • Fluvastatin Er (fluvastatin sodium)
  • Fluvastatin Sodium (fluvastatin sodium)
  • Gemfibrozil (gemfibrozil)
  • Juxtapid (lomitapide mesylate)
  • Kynamro (mipomersen sodium)
  • Lescol (fluvastatin sodium)
  • Lescol Xl (fluvastatin sodium)
  • Lipitor (atorvastatin calcium)
  • Lipofen (fenofibrate)
  • Liptruzet (ezetimibe/atorvastatin calcium)
  • Livalo (pitavastatin calcium)
  • Lofibra (fenofibrate)
  • Lofibra (fenofibrate,micronized)
  • Lopid (gemfibrozil)
  • Lovastatin (lovastatin)
  • Mevacor (lovastatin)
  • Niacin Er (niacin)
  • Niacor (niacin)
  • Niaspan (niacin)
  • Praluent Pen (alirocumab)
  • Praluent Syringe (alirocumab)
  • Pravachol (pravastatin sodium)
  • Pravastatin Sodium (pravastatin sodium)
  • Prevalite (cholestyramine/aspartame)
  • Questran (cholestyramine (with sugar))
  • Questran Light (cholestyramine/aspartame)
  • Repatha Pushtronex (evolocumab)
  • Repatha Sureclick (evolocumab)
  • Repatha Syringe (evolocumab)
  • Rosuvastatin Calcium (rosuvastatin calcium)
  • Simcor (niacin/simvastatin)
  • Simvastatin (simvastatin)
  • Tricor (fenofibrate nanocrystallized)
  • Triglide (fenofibrate nanocrystallized)
  • Trilipix (fenofibric acid (choline))
  • Vytorin (ezetimibe/simvastatin)
  • Welchol (colesevelam hcl)
  • Zetia (ezetimibe)
  • Zocor (simvastatin)

Diagnosis Codes:

ICD-10: E78.0, E78.00, E78.2, E78.4, E78.5