PAN Foundation

Enrollment Application

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Patient Access Network Foundation (PAN) is committed to helping patients in need get access to their medications by providing co-payment assistance. Patients can submit their application online by answering basic questions. Please check the specific disease page to see if funding is currently available. Please note that only eligible patients will be able to proceed past Step 3.

Using the menus below, please select the disease fund, patient’s primary insurance type and the medication(s) for which assistance is being requested.
Select Disease Fund

Select Primary Insurance Type

Select Medication (All that Apply)
* Press and hold the Ctrl key to select multiple Medications

*Do you reside and receive treatment in the US?:
  
QUESTIONS OR CONCERNS? PLEASE CONTACT US AT: 866-316-PANF (7263)