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Organogenesis Inc is committed to providing access to Apligraf® for those most in need through the Apligraf® Patient Assistance Program. This program provides assistance to patients experiencing financial hardship who have no public or private insurance coverage.

PAP Guidelines:

• Patient must be a U.S. resident
• Eligibility is determined on a case by case basis
• Patient must supply proof of income – 1040 Tax Form or SSI statement along with application completed and signed
• Patient must have no public or private insurance coverage (this program is not a co-payment assistance program)

Please print and fill out the Apligraf® Patient Assistance Program Application and fax to: 1-866-212-2888.

For more information please call 1-888-HEAL-2-DAY (1-888-432-5232), option #3.