Get Sunovion Patient Assistance Application

This guide provides clear and supportive instructions for completing the Sunovion Patient Assistance Application online. By following the steps outlined below, users will be able to efficiently fill out the necessary details to apply for assistance with their Sunovion prescription.

Follow the steps to complete your application successfully.

1. Use the ‘Get Form’ button to access the application and open it in your preferred online document editor.
2. Begin by providing your personal information in the 'Patient Information' section. Fill in your full name, date of birth, phone number, gender, and mailing address. Ensure that each field is completed accurately.
3. Next, move to the 'Household Income Information' section. Confirm whether the patient is a US resident and whether they are 18 years or older by selecting 'YES' or 'NO'. Specify the number of people in the household and indicate the total gross annual household income.
4. Attach the required documentation to verify the household income. Options include current paycheck stubs, proof of Social Security income, or a federal tax return from the previous year. If applicable, request a Verification of Non-Filing from the IRS if a tax return was not filed.
5. Proceed to the 'Patients Insurance Information' section. Indicate if the patient is enrolled in Medicare or Medicaid and whether they have additional prescription drug coverage. Provide details as necessary.
6. In the 'From the Healthcare Professional' section, ensure that the prescribing healthcare professional completes the required fields, including their name, contact information, and licensing details.
7. Fill out the 'Prescription Information' section, specifying the dosage, day supply, method of delivery, and number of refills required for the prescribed medication.
8. Review the 'Your Consent is Required' section and ensure that all parties involved, including the patient and healthcare professional, have signed and dated the application. Confirm that you understand the program terms and conditions.
9. Once all sections are completed and checked for accuracy, save your changes. You may choose to download, print, or share the filled application as needed.

Complete your application online today to request your Sunovion prescription assistance.