HOW THE NORD/MYLAN CYSTAGON® DRUG ASSISTANCE PROGRAM WORKS WHO CAN APPLY?
People with nephropathic cysitnosis who are prescribed Cystagon® but cannot afford to purchase the drug are eligible for this program. They must be diagnosed with nephropathic cystinosis by a licensed physician. All applicants must be citizens or permanent residents of the United States. Specific medical and financial information will determine if a person is eligible for the CDA Program. The patient/applicant must show financial need. They cannot be eligible for federal or state medical reimbursement programs. THE APPLICATION: • In order to be considered for the CDA Program, the patient (or parent/guardian) must complete and sign the application. • A copy of the family income tax form with W-2 form(s) from the most recent year filed is required. A photocopy of the last three pay stubs, or Social Sceurity Disability statement(s) are also needed. • The applicant must obtain a medical statement from a physician regarding the patient’s diagnosis and recommended dosage of Cystagon®. • The
