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Inherited Retinal Disease Travel

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Program Status

Currently Closed – We are no longer accepting or processing applications for new or renewal patients.

 

Travel Assistance Programs

 

 

Assistance Amount

$10,800 per year. Patients may apply for a second grant during their eligibility period subject to availability of funding.

 

 

Eligibility Criteria

  1. The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
  2. The patient must have health insurance that covers his or her qualifying medication or product. 
  3. The patient’s medication or product must be listed on PAN’s list of covered medications.  
  4. Patient must be required to travel more than 20 miles (one way) to receive their prescribed treatment. Exceptions to distance requirements are made for patients living in large metropolitan cities.
  5. The patient’s income must fall at or below 500% of the Federal Poverty Level.
  6. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
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See the list of medications covered in this program
View List  
  • Algal Omega-3 Dha (docosahexanoic acid)
  • Aquasol A (vitamin a palmitate)
  • Atabex Dha 200 (docosahexanoic acid)
  • Avastin (bevacizumab)
  • Beta Carotene (beta-carotene)
  • Bevacizumab (bevacizumab)
  • Coromega (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Dha (docosahexanoic acid)
  • Dha Algal-900 (docosahexanoic acid)
  • Epa-Dha 720 (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Extreme Omega-3 Microgel (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Eylea (aflibercept)
  • Fish Oil (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Fish Oil (omega-3 fatty acids/fish oil)
  • Lovaza (omega-3 acid ethyl esters)
  • Lucentis (ranibizumab)
  • Lumitene (beta-carotene)
  • Lutein (lutein extract/zeaxanthin extract)
  • Lutein (lutein)
  • Lutein (lutein/zeaxanthin)
  • Lutein-Zeaxanthin (lutein/zeaxanthin)
  • Natural Lutein (lutein)
  • Ocuvite Lutein 25 (lutein/zeaxanthin)
  • Omega-3 (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Omega-3 Acid Ethyl Esters (omega-3 acid ethyl esters)
  • Omera (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Prenatal Dha (docosahexanoic acid)
  • Super Dha Gems (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Theromega (omega-3 fatty acids/docosahexanoic acid/epa/fish oil)
  • Triklo (omega-3 acid ethyl esters)
  • Vitamin a (vitamin a)

Diagnosis Codes:

ICD-10: H35.50-H35.54, H31.21

 

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