Healthcare Providers
  • The Safety Net Foundation ships all products through a single fulfillment vendor, RxCrossroads®.
  • RxCrossroads® has both pharmacy and wholesale licenses, allowing two fulfillment delivery models for replacement products offered by the Foundation. The pharmacy model allows The Safety Net Foundation to ship exact order quantities, while the wholesale model allows The Safety Net Foundation to ship wholesale volumes to sponsoring facilities.
  • The replacement order form has been designed to accommodate both fulfillment models.
  • In order to receive exact quantity shipments for your request, the physician must sign the product request form. If the physician does not sign this form, and only the sponsor contact signs it, SNF will ship the closest wholesale quantity and credit any remaining balance to your facility.

About the Patient Enrollment Application
For Nplate™ and Sensipar® providers or patients should submit a Patient Enrollment Application (Form B) and Prescription Form (Form C) for  for each patient to be considered for Foundation eligibility.  Completion of the application form requires the patient’s signature.

For Aranesp®, EPOGEN®, Neulasta®, Vectibix®,  and NEUPOGEN®: we recommend that providers call The Safety Net Foundation to pre-assess patients prior to submitting a form. Foundation staff can complete some portions of the application and send to the provider or patient for completion and signatures.

How Will My Patient Receive Product?
The Safety Net Foundation provides product on a replacement basis for Aranesp®, EPOGEN®, Neulasta®, and NEUPOGEN® and Vectibix®. In order to request product replacement for a patient, the sponsor must submit a Product Order Form (Form C) to document the patient’s product usage.

For Nplate® and Sensipar®, product will be shipped prospectively by a specialty pharmacy upon receipt of the prescription.

 
The Safety Net Foundation reserves the right to approve or deny any Safety Net Foundation application or to modify or discontinue the program with respect to any patient or provider, or in its entirety, at any time. The Safety Net Foundation reserves the right to make an independent determination of eligibility in all cases.