How to Apply:Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to PPA.
- Click here to visit the program's web site.
Eligibility:
The Safety Net Foundation is designed to assist those patients who are uninsured and with limited or no financial resources. Eligibility is based on US residency, insurance status and income criteria. To enroll a patient, providers and patients should visit our website at www.safetynetfoundation.com or call us at (888) 762-6436.
Other Information:
For Nplateand Sensipar® providers or patients should submit a Patient Enrollment Application for each patient to be considered for Foundation eligibility. Completion of the application form requires the patient's signature.
For Aranesp®, EPOGEN®, Neulasta®, Vectibix®, and NEUPOGEN®: we recommend that providers call The Safety Net Foundation to pre-assess patients prior to submitting a form. Foundation staff can complete some portions of the application and send to the provider or patient for completion and signatures.
The Safety Net Foundation reserves the right to approve or deny any Safety Net Foundation application or to modify or discontinue the program with respect to any patient or provider, or in its entirety, at any time. The Safety Net Foundation reserves the right to make an independent determination of eligibility in all cases
Product(s) covered by program:
- Aranesp®
- EPOGEN®
- Neulasta®
- Neupogen®
- Nplate®
- Sensipar
- Sensipar®
- Vectibix®