Before you begin our full application, we recommend that you review our eligibility requirements to see if you are eligible:
Applicant must have a bona fide diagnosis of CF;
Applicant must be a permanent resident of the United States;
Applicant must be requesting assistance for at least one FDA approved drug specifically indicated for the treatment of CF; and
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 meet these requirements, go to Step 2: Complete the Application.
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 card;
Estimate of the patient's household income and household size;
List of prescribed and currently taken medications and devices; and
List of other assistance programs.
Step 2: Complete the Application
Click below to complete an application online or download a printable copy. You can also request a copy by calling (888) 315-4154.