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DirectMemberReimbursementForm:MedicationsandTreatments PANgrantrecipientscansubmitapprovedexpensesforreimbursementusingthisDirectMember Reimbursement(DMR)form. YoudonotneedtocompleteaDMRformifyourhealthcareproviderorpharmacisthassubmitted or.

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Related content

PAN Foundation: Homepage
PAN Foundation homepage ... PAN Foundation homepage ... Nonprofits 2020 Top-rated...
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Independent charitable patient assistance foundations—like PAN—have long been recognized by the U.S. government for their role in providing a critical safety net for patients on Medicare and commercial insurance who are living with life-threatening, chronic, and rare diseases.

PAN Foundation grants provide a fast, reliable way to pay for out-of-pocket medication costs, health insurance premiums, and transportation expenses. We offer grants to help you with out-of-pocket medication copay costs, health insurance premiums, and transportation for activities that benefit your overall health.

Founded in 2004, the Patient Access Network Foundationâ„¢ is one of the nation's largest charitable organizations, providing financial assistance that helps people afford their prescription medications.

You can also use our 24/7 self-service option by calling 1-866-316-7263 and pressing 1 when prompted. You'll need to provide the patient's PAN member ID and date of birth. If you need more help, call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET. to talk to our contact center representatives.

PAN's health insurance premium grants help pay for health insurance premiums for patients being treated for various disease states. Our health insurance premium grants offer funds to cover a portion of your premium costs.

You can also use our 24/7 self-service option by calling 1-866-316-7263 and pressing 1 when prompted. You'll need to provide the patient's PAN member ID and date of birth. If you need more help, call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET. to talk to our contact center representatives.

Grant eligibility periods are 12 months with a look back period of 90 days for any initial grant. At the end of the grant eligibility period, you have 60 days to submit any outstanding claims with dates of services within the eligibility period.

How our grants work. We provide grants to help pay for medication copay costs, health insurance premiums, and transportation for a 12-month period, in full compliance with all relevant laws, regulations, and government guidelines. The amount of assistance you receive, and eligibility requirements, vary by disease fund.

When you are approved for a PAN copay grant, you can use your funds right away. You choose the providers you use, which pharmacies you use, and which covered medications in PAN's disease fund formulary you want to use it on that have been prescribed by your provider.

In general, to qualify for a PAN grant, you (or your patient) must meet these criteria: You're getting treatment for the disease named in the disease fund. Your prescribed medication must be listed as a covered medication for your disease fund. You have health insurance that covers your qualifying medication or product.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232