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Forms

Instructions for Renassist Insurance Verification & Patient Assistance Application
Renassist Insurance Verification Form & Patient Assistance Application*
HCP Patient Authorization Form 
Patient Authorization for Release of Information to Renassist Form
Limited Income Subsidy (LIS) Document 
Verification of Benefits Form

Links

Medicare Part D

Medicare Part D Limited Income Subsidy (LIS) Information
Medicare Website

Alternative Funding Resources
Healthwell Foundation
AKF Medicare Part D Grant Program for Rx Bone Disease Medication
American Kidney Fund

Other
State Medicaid and Public Health Insurance Programs
Centers for Medicare and Medicaid Services
State Pharmaceutical Assistance Programs (SPAPs)
RxAssist

*The Renassist Insurance Verification Form and Patient Assistance Application and the Verification of Benefits form must be filled out and submitted to Renassist via fax or email to 877-363-6732 or PAP@genzyme.com.

*If you do not have Adobe Reader version 9.0 or higher, be sure to save the application onto your desktop before electronically entering information to ensure that your work is captured and saved.

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Genzyme Corporation
Renassist
500 Kendall Street
Cambridge, MA 02142
T: 800 847 0069
F: 877 363 6732

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