Sanofi Patient Assistance Connection

Requirements for uninsured applicants

• Patient must be at or below 400% federal poverty level to qualify
  • View federal poverty guidelines
• Medications are shipped to the providers office
  • Will not ship more than a 90-day supply
  • Earliest you can order is 60 days after a fill is completed
• Do not have to submit income with application, company will perform a soft credit inquiry to get this information
• You do not need to send in a prescription, application serves as a prescription
• Applications are good for 1 year from the date approved by the program

Requirement for Medicare Part D applicants

• Medicare Part D enrollees can apply once they have spent 2% of their total income on medications year to date
  • If they are not sure, submit an application and the company will let you know how far away they are
• Applications for Medicare Part D enrollees are valid until December 31st of the current enrollment year