Patient Assistance Program
What is the Patient Assistance Program (PAP)?
The MIMEDX Patient Assistance Program assists uninsured patients who are unable to afford EPIFIX and EPICORD products.
Criteria
Product that is free of cost is awarded to patients in need who meet all the below criteria:
The Patient is a United States citizen or a lawful permanent resident in the United States or Puerto Rico.
The Patient is under the direct care of a licensed HCP, who is practicing medicine in the U.S. or Puerto Rico.
The Patient is prescribed a Company product for the treatment of a Diabetic Foot Ulcer (DFU) or a Venous Leg Ulcer (VLU) for which standard of care treatment has failed.
The patient does not have health insurance (i.e., commercial, governmental, state, local, or special services).
The patient has a household income that falls below 250% of the federal poverty guidelines as published annually by HHS at: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines.
Download Forms
Fax the completed form to MIMEDX customer service at 770.590.3552
There are both provider and patient sections requiring attestation that the patient meets the criteria to apply for the program.
All forms must be completed; incomplete forms will be denied.
How Will I Learn if the Patient is Approved?
For each application, MIMEDX will communicate one of three outcomes to the provider:
