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Arestin Rx Access Co-Pay
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Phone
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855-684-7481
Fax:
855-630-9783
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Eligibility
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This program is for Healthcare Professionals Only.
Patients must have no insurance. Patients must be 18 years old or older and must be treated by a US doctor. |
Who Can Apply
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Healthcare providers can call to have an application faxed or download one. |
Required
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Doctors must enroll in the program, complete the form and obtain patient consent. Patients must complete a section of the form and sign. The application must then be faxed from the doctor's office. |
Supply
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Not specified |
Ship To
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Not specified |
Note
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Co-Pay Assistance expires 12/31/2016. The offer is only valid for patients with private insurance. |
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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. |
Arestin powder; extended release |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
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