Gilenya (fingolimod)
Patient Assistance Program Guide — Novartis Patient Assistance Foundation (NPAF)
Do You Qualify?
Income
Up to $75,300 for a single person
Insurance
Uninsured, underinsured, or Medicare Part D patients who meet specific NPAF financial and clinical criteria
Residency
U.S. resident with a valid U.S. address
Income Limits (500% FPL)
Income threshold calculated at 500% FPL for 2025; specific cases may be reviewed based on financial hardship
Based on 2025 HHS Federal Poverty Level guidelines.
# Getting Gilenya (Fingolimod) at Low or No Cost Through the Novartis Patient Assistance Foundation (NPAF)
Who Qualifies for the Novartis Patient Assistance Foundation (NPAF)?
If you cannot afford Gilenya (fingolimod), you may be able to get it at no cost through the Novartis Patient Assistance Foundation (NPAF). This program is designed specifically for patients who lack adequate insurance coverage and meet financial eligibility criteria. For a single-person household, your annual income must be at or below $75,300 to qualify. In general, you must be uninsured, underinsured, or enrolled in Medicare Part D — standard Medicaid coverage typically makes you ineligible. If you meet these requirements and have a valid prescription from your doctor, this program may be able to provide your medication at no charge.
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About Gilenya (Fingolimod)
Gilenya (fingolimod) is a prescription medication approved by the FDA to treat relapsing forms of multiple sclerosis (RMS). This includes clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive disease. It belongs to a drug class called sphingosine 1-phosphate (S1P) receptor modulators and is taken as a once-daily oral capsule. Without insurance or financial assistance, Gilenya can cost several thousand dollars per month, making it unaffordable for many patients. A generic version, fingolimod, is also available and may be a lower-cost alternative worth discussing with your doctor.
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Income Eligibility: Full Breakdown
The NPAF uses income limits set at 500% of the Federal Poverty Level (FPL) for 2025. Your household size determines the maximum income you can earn and still qualify. Here is a full breakdown:
| Household Size | Maximum Annual Income |
|---|---|
| 1 person | $75,300 |
| 2 persons | $102,200 |
| 3 persons | $129,100 |
| 4 persons | $156,000 |
Income is typically verified using your most recent federal tax return, a W-2, or three months of recent pay stubs. The program generally looks at your prior year's reported income, though current income documentation is also accepted.
If your income is above these limits, you may not qualify under standard criteria. However, the NPAF notes that specific cases may be reviewed based on financial hardship. This means that even if your income slightly exceeds the threshold, it may be worth applying and explaining your situation. Unusual expenses, medical bills, or other financial burdens could be considered during the review process. Do not assume you are automatically disqualified before contacting the program.
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Insurance Requirements Explained
Your insurance status plays a major role in whether you qualify for NPAF. Here is how different situations are handled:
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Step-by-Step: How to Apply
Follow these steps to apply for free Gilenya through the NPAF:
1. Gather your documents first. You will need: a completed and signed NPAF application form, proof of income (most recent tax return, W-2, or three months of pay stubs), and a valid prescription from your licensed healthcare provider.
2. Download or request the application form. Visit the official program page at https://www.novartis.com/us-en/patients-and-caregivers/patient-assistance/novartis-patient-assistance-foundation-inc to access the application. You can also find program information at https://www.gilenya.com/support.
3. Choose your submission method. You may apply in one of several ways:
- Online: Use the link above to submit electronically.
- Phone: Call (800) 277-2254 to apply with assistance or ask questions.
- Fax: Send completed documents to (855) 817-2711.
4. Have your doctor complete their portion. The application requires your prescriber's signature and clinical information confirming your MS diagnosis and treatment plan.
5. Submit everything together. Incomplete applications slow down the process. Double-check that all forms are signed and all income documents are included before submitting.
6. Wait for confirmation. After submission, processing typically takes 7 to 10 business days. You will be contacted regarding your approval status.
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What to Expect: Timeline and Delivery
After you submit a complete application, the NPAF typically takes 7 to 10 business days to process your request. Once approved, you will receive confirmation, and your medication will be shipped directly to your home address — you do not need to pick it up at a pharmacy or your doctor's office. Make sure your mailing address is accurate on your application. You will not need to pay at delivery.
Your approval is not permanent. The NPAF requires annual reauthorization, meaning you will need to reapply and re-verify your income and eligibility once per year. Watch for renewal notices and begin the reauthorization process early to avoid any gaps in your medication supply.
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Alternatives If You Don't Qualify
If you do not meet the NPAF criteria, there are still options worth exploring:
1. Generic fingolimod: A generic version of Gilenya is available and may cost significantly less than the brand-name drug. Ask your doctor whether fingolimod is an appropriate option for you.
2. Gilenya Co-Pay Card (for insured patients): If you have commercial insurance, you may qualify for a savings card that reduces your out-of-pocket costs. Learn more at https://www.gilenya.com/patient/co-pay-card/.
3. State Pharmaceutical Assistance Programs (SPAPs): Many states offer programs that help residents pay for prescription drugs, particularly for seniors or people with disabilities. Search your state's health department website or ask your pharmacist for details.
4. NeedyMeds.org: This free, nonprofit database lists hundreds of patient assistance programs, drug discount cards, and state programs. Visit www.needymeds.org to search by drug name or condition at no cost.
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*This guide is for informational purposes only and does not constitute medical or legal advice. Eligibility determinations are made solely by Novartis. Program terms may change — verify current requirements at [https://www.gilenya.com/support](https://www.gilenya.com/support) before applying.*
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Documents You'll Need
If You Don't Qualify for the Assistance Program
Biosimilar / Generic Alternatives
FDA-approved alternatives to Gilenya: fingolimod (generic). Ask your prescriber if one of these is clinically appropriate for your condition.
Manufacturer Savings Card (for insured patients)
Novartis offers a savings card that may reduce your out-of-pocket cost if you have commercial insurance. Ask your prescriber or pharmacist for current savings card details.
Common Questions
After submitting a complete application with all required documents, the NPAF typically takes 7 to 10 business days to process your request. Missing documents can delay this timeline, so make sure your application is fully complete before submitting.
Yes. Unlike many patient assistance programs that exclude Medicare beneficiaries, the NPAF does accept patients with Medicare Part D coverage who meet the income and clinical eligibility requirements. You should still apply if you are having trouble affording Gilenya.
If approved, your Gilenya will be shipped directly to your home address. You do not need to pick it up at a pharmacy or your doctor's office. Make sure the address on your application is current and accurate.
The NPAF requires annual reauthorization. Before your approval period ends, you will need to reapply and re-verify your income and eligibility. It is a good idea to start the renewal process early to avoid any interruption in receiving your medication.
The NPAF may still review your case if you are experiencing significant financial hardship, even if your income is slightly above the standard threshold. It is worth applying and explaining your circumstances rather than assuming you do not qualify.
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