If you are a CF patient or a patient advocate, you may apply for assistance to the Cystic Fibrosis Patient Assistance Foundation (CFPAF) at any time. Here's how:
Step 1: See if you meet our basic qualifications
Our program is not for everyone, and we value your time. So before you begin our full application, we recommend that you first review our eligibility requirements to see if you are eligible:
Applicant must have a bona fide diagnosis of cystic fibrosis
Applicant must be requesting assistance for an FDA approved medication or paired drug delivery device for the nebulized treatment of cystic fibrosis related pulmonary disease, or an FDA approved medication for the treatment of pancreatic insufficiency related to cystic fibrosis.
Applicant must be a permanent resident of the United States.
Applicant's household income must be equal to or less than 400 percent of the federal poverty level for a single CF patient household, or equal to or less than 500 percent of federal poverty level for a multiple CF patient household.
If you believe you meet these requirements, go to Step 2: Complete the Application. If after reviewing the requirements you believe you are not eligible for the CFPAF program, you may be eligible for Other Patient Assistance Programs click the link to learn more. But, if you are still unsure, we can help determine your eligibility, either through:
Online screening:
or
Phone screening: Call us at 888-315-4154 and ask to be prescreened. When you call, please have the following information available:
Patient's name, address, telephone number, and date of birth
Patient's insurance information (have the insurance card handy)
Estimate of the patient's household income and household size
Medications and devices patient is taking or is prescribed
Any other assistance programs patient has applied to or enrolled in
Step 2: Complete the Application
You can obtain the application either by calling us (888-315-4154) and having us mail, email or fax it to you; or by simply downloading the application here.
or
Notarized Letter only to be completed in absence of 1040 tax document.
To view the item above you will need to download Adobe Acrobat Reader.
Step 3: Submit the Application
To ensure that we can process your application smoothly and quickly, please make sure you have provided all the requested information and the required income and residency documents. Once complete, if you have submitted the online application you are done. To submit the writable PDF application, you can submit the application one of two ways:
Once we have received all required documentation, we will process your application within 10-15 business days and notify you of our decision via phone call and letter.
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