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Solstice Co-Pay Assistance Program
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4700 Millenia Blvd., Suite 310
Orlando, FL 32839
Phone
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888-461-2255
Ext 3
Fax:
888-343-3275
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Eligibility
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Patients must not have public insurance but may have private insurance. Patients must be at or below 350% of the Federal Poverty Level and have Cervical Dystonia. Massachusetts residents are not eligible. |
| Who Can Apply
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Doctor of hospital must call to have an application faxed or mailed. |
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Required
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Doctor starts the process by submitting an insurance verification request online or via fax. Patients must complete a section of the application, sign, attach proof of income and attach any insurance information. |
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Supply
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Not applicable |
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Ship To
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Not applicable |
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Note
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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.
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| Myobloc (botulinum toxin type B) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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