Viltepso

Indicated For

Duchenne muscular dystrophy (DMD)

About This Medication

# NS Support Patient Assistance Program: How to Get Viltepso at Low or No Cost ## About Viltepso Viltepso (viltolarsen) is a prescription medication used to treat Duchenne muscular dystrophy (DMD), a rare genetic disorder affecting muscle strength and function. The NS Support Patient Assistance Program helps eligible patients access this medication at reduced or no cost. ## Who Qualifies for This Program To be eligible for the NS Support Patient Assistance Program, you must meet the following requirements[1][2]: - Be a U.S. citizen or permanent resident living in the United States or its territories - Be receiving treatment from a U.S. licensed physician as an outpatient - Be uninsured or underinsured - Not be covered by government health insurance programs (Medicare, Medicaid, CHIP, or TRICARE)[9] - Demonstrate financial need through income documentation ## Income Eligibility The program requires patients to submit accurate and complete financial documentation to validate income levels[1]. While specific income thresholds are not publicly detailed in program materials, the program uses a needs-based assessment approach. Patients must provide documentation of all household income sources and household size[2]. | Income Documentation Required | Details | |------|----------| | Household income sources | All sources must be documented | | Household size | Number of dependents affects eligibility | | Financial need assessment | Program evaluates ability to pay | ## Insurance Requirements The program is designed for **uninsured and underinsured patients**[9]. If you have commercial insurance, you may be eligible for the **NS Support Access Solutions copay assistance program** instead, which offers up to $20,000 in annual benefits[7]. Patients with government insurance programs (Medicare, Medicaid, CHIP, TRICARE) are not eligible for this patient assistance program. ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following[1][2]: - Completed Patient Assistance Program Application Form - Financial documentation (proof of income, tax returns, pay stubs) - Current prescription from your physician - Patient Authorization Form (signed by patient, parent, guardian, or legal representative) - Physician information including DEA number, Tax ID, or State License number ### Step 2: Complete the Application The application requires three main sections[2]: 1. **Patient Information (Sections 1-3)**: Your name, address, contact information, and relationship to the patient if applicable 2. **Financial Information (Section 2)**: All household income sources and household size 3. **Authorization (Section 3)**: Signature from patient, parent, guardian, or legal representative ### Step 3: Obtain Physician Signature Your healthcare provider must complete and sign the Prescription Information section (Section 5) of the application[1]. They will provide their contact information, DEA number, and prescription details. ### Step 4: Submit Your Application Mail or fax your completed application with all supporting documents to[1][5]: **Mailing Address:** NS Support Patient Assistance Program PO Box 29203 Phoenix, AZ 85038-9203 **Fax:** 888-212-0482 **Phone:** 833-NSSUPRT (833-677-8778) Monday–Friday, 8 AM to 8 PM ET Applying is completely free[1]. ## Timeline and What to Expect **Processing Time**: NS Support will verify your eligibility and process your application. Benefits verification typically takes 2 business days[8]. **Approval Duration**: Once approved, you will be eligible to receive assistance for **one year from the date of application**[1]. You will receive a notice 45 days before your enrollment expires, reminding you to reapply[2]. **Medication Delivery**: Approved medications are shipped directly to you or your physician. Please note that the program covers only the cost of Viltepso medication—not infusion services or healthcare provider visits, which remain your responsibility[1]. ## What Happens If Your Application Is Denied If your application is denied, contact NS Support at 833-677-8778 to understand the reason. Common reasons for denial include: - Income exceeding program limits - Eligibility for government insurance programs - Incomplete or missing documentation - Not meeting residency requirements You may be able to reapply if your circumstances change, or NS Support staff can discuss alternative assistance options. ## Reauthorization and Ongoing Participation The program requires annual reauthorization[1]. Here's what you need to know: - You must reapply every year by completing a new NS Support Patient Assistance Program Form - You will receive a reauthorization notice 45 days before your current enrollment expires[2] - You must notify NS Support of any changes in your total gross income or household composition[2] - Approved patients are automatically reenrolled for 12 months if they continue to meet eligibility requirements[7] ## Important Program Limitations - The program covers **only the cost of Viltepso medication**, not infusion services, healthcare provider visits, or other medical expenses - You must be an outpatient (not hospitalized) to qualify - Government insurance beneficiaries are not eligible - Your personal health information will be shared with NS Pharma and its agents for enrollment and case management purposes ## Questions or Need Help? Contact NS Support Patient Assistance Program: **Phone:** 833-NSSUPRT (833-677-8778) **Hours:** Monday–Friday, 8 AM to 8 PM ET **Fax:** 888-212-0482 **Mailing Address:** PO Box 29203, Phoenix, AZ 85038-9203 ## Disclaimer This guide provides general information about the NS Support Patient Assistance Program for Viltepso. Program eligibility, benefits, and requirements may change. For the most current and complete information, contact NS Support directly or visit the official Viltepso website. This information is not a guarantee of program enrollment or medication coverage. Always consult with your healthcare provider about your treatment options.

Program information last verified: March 30, 2026