Patient Insurance
Travel Assistance
Patient's Home Address:
To qualify for PAN’s travel assistance programs, the patient must be required to travel more than 20 miles (one way) to receive his or her prescribed treatment. Exceptions to distance requirements are made for patients living in large metropolitan cities. See PAN’s Travel FAQs for details.
Please find additional details on PAN's Travel FAQ .
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Your treatment facilities
Treatment Facility | Address | City | State | ZIP | Distance from home | Action |
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Please attach copy(ies) of your appointment schedule.
Document Name | Size | Date | |
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Treating Provider
No matching providers were found, please revise your search and try again. For assistance, please contact the PAN call center at 1-866-316-7263.
Please select the treating/prescribing provider from the list below. If more than one provider is associated with the patient's treatment, select the primary provider.
Please note: PHI will be shared with the prescribing provider selected below.
First Name | Last Name | NPI | Organization | Address | City | State | ZIP | |
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Only first 100 records are displayed in the search results. Please refine your search to narrow the results.
Education and Support Services
Copay Assistance Program
The manufacturer of your selected drug(s) has copay assistance program(s) for those with commercial insurance.
Please print or email this screen for your records. See additional information below: