KINERET Patient Assistance Program Application
KINERET ® Patient Assistance Program Application Application Instructions IMPORTANT – PLEASE COMPLETE THIS APPLICATION AND FOLLOW THE INSTRUCTIONS BELOW: 1. Enclose a valid prescription.
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(incidence ≥ 5%) worsening of rheumatoid arthritis
www.kineretrx.comFULL PRESCRIBING INFORMATION 1 INDICATIONS AND USAGE 1.1 Active Rheumatoid Arthritis Kineret is indicated for the reduction in signs and symptoms and slowing the progression of structural damage in moderately to severely active rheumatoid
Patient Assistance Program Application - KineretRx.com
www.kineretrx.comMedicaid Provider ID #: _____ ... does not promise to find ways to pay for the patient’s prescription, and I know that I am responsible for the costs of the patient’s care. ... education, and other support services offered now or in the future. As part of the Program offerings, I agree to enrollment in the copay assistance program if I am ...
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