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Novartis Patient Assistance Foundation, Inc.
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PO Box 52029
Phoenix, AZ 85072
Phone
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800-277-2254
Fax:
855-817-2711
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must be a US resident. |
Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
Required
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Doctors must complete a portion of the application, sign and attach a prescription for 90 days. Patients must complete a portion of the application, sign and attach a copy of proof of income. |
Supply
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Varies |
Ship To
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Doctor's office or patient is sent card to be used at pharmacy. |
Note
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For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician. |
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Includes Support for This Drug NOTE: Linked drugs are available for Prescribers to Apply Online now. Click drug logo or drug name to start online application. |
Reclast injectable; iv (infusion) |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
Download printable Form |
(Requires Acrobat Reader)
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