Information for Caregivers
As a caregiver, you may want to help the person you're caring for through the application process. It's important to find out how the person you care for could receive up to 12 prescription fills of medication at no cost. Here's how you can help.
Check to see if the person you care for is eligible to participate in the program
- Help them fill out the application form and have them sign it
- Get their healthcare professional's signature on the form
- Make sure all the required documents are sent with the form
- Include the medication prescription from their healthcare professional
To help you and the person you're caring for track each step of the application process, a handy checklist is provided below.
Applying for the program takes 5 easy steps
It's easy to apply for Sunovion Support®. Just follow the 5 easy steps below. If you have a question at any point in the process, please call the toll-free number at 1-877-850-0819 to speak with a Sunovion Support® Specialist.
1. Find out if the person you're caring for is eligible
Click here to check the patient's eligibility.
2. Fill out an application form
There are several ways to get an application form. It can be found via one of the eligiblity links above, or by calling the toll-free number at 1-877-850-0819 and speaking with a Sunovion Support® Specialist.
You will need to include proof of income with the application form
Please include information about the patient's annual income and proof of income with the application form. (For example: Most recent federal tax return/1040 form/1040EZ form or Social Security Statement).
- If patient has not filed a Federal Tax Return, they can request a free Verification of Non-Filing by visiting www.IRS.gov and click on "Order a Transcript" or call 1-800-908-9946. Use Form 4506-T and check box 7 to request Verification of Non Filing.
3. Ask the patient's healthcare professional to complete their part of the process
The healthcare professional must fill out their section of the application form and sign it. Include the patient's prescription when sending in the application.
4. Send in the form
Mail the application form, with required documents, in an envelope to the address below:
PO Box 220285
Charlotte, NC 28222-0285
Or you can FAX to:
5. Your Application is processed
Each application is checked to see if the applicant qualifies for the Program. Forms must include all requested documents to be complete.
The Program will contact you and your healthcare professional if you qualify or if the application form is missing information or documents.
Please note that the patient is free to switch their healthcare professional at any time while participating in the program. It will not affect their eligibility for prescription assistance. Sunovion Support® is offered to them regardless of which healthcare professional or pharmacy they choose.
Here's a handy checklist to help them track the steps as you complete them:
- Review their eligibility for the Program
- Help them complete the application form and have them sign it
- Ask their healthcare professional to fill out their section of the application form and sign it
- Send their prescription with the form
- Send proof of income with the form
- Put a stamp on the envelope
- Make a copy of the form and other documents for your files
If it's easier, FAX your application and other documents to: 1-877-850-0821
Have questions or want to learn more about the Program?
Please call the toll-free number to speak with a Sunovion Support® Specialist.
Sunovion reserves the right to modify or revoke this program at any time.