Synagis Patient Assistance Program - Patient Assistance Programs

Summary

MedImmune, LLC, the biologics division of AstraZeneca, is a Maryland-based company that specializes in infectious disease, respiratory illness, and inflammation. The company manufactures and markets SynagisÂ® (palivizumab), which is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients at high risk of RSV disease. Safety and efficacy were established in infants with bronchopulmonary dysplasia (BPD), infants with a history of premature birth (â‰¤35 weeks gestational age), and children with hemodynamically significant congenital heart disease (CHD). Synagis is administered by injection under the supervision of a physician.

Eligibility

The MedImmune Assistance Program (MAP) offers Synagis at no cost to those who are eligible for the program. A physician must order the medication, and it will be sent to the site of treatment (usually the doctorâ€™s office). Patients must re-apply to the program every year. Eligibility is based on the following requirements:

- You must not be covered by private or public health insurance.

- You must meet an income guideline of 400% or less of the Federal Poverty Guideline.

- You must be a resident of the United States, currently under the care of a United States doctor.

SOURCE: 2008 Poverty Chart

Family Size

300%

250%

200%

150%

133%

100%

$32,490

$27,075

$21,660

$16,245

$14,404

$10,830

$43,710

$36,425

$29,140

$21,855

$19,378

$14,570

$54,930

$45,775

$36,620

$27,465

$24,352

$18,310

$66,150

$55,125

$44,100

$33,075

$29,327

$22,050

$77,370

$64,475

$51,580

$38,685

$34,301

$25,790

$88,590

$73,825

$59,060

$44,295

$39,275

$29,530

$99,810

$83,175

$66,540

$49,905

$44,249

$33,270

$111,030

$92,525

$74,020

$55,515

$49,223

$37,010

Each Additional Family Member

$11,220

$9,350

$7,480

$5,610

$4,974

$3,740

What´s Next?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Medimmune, Inc. program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Other Tips

If you have any questions please call the Medimmune, Inc. program directly.
Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in.
Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don't run out of medication.
Do not write messy on your forms as this will delay any response.
Call and write thank you notes to AAI Pharma Inc. program. Without their help millions of people will be without medication.