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Matulane Patient Assistance Program
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Matulane Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone
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855-653-3220
Fax:
203-349-3282
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. Patient must also have a diagnosis of Stage III or IV Hodgkin's Disease or have another lymphoma where a physician feels a response is possible.The patient must also be a US resident. |
| Who Can Apply
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Anyone with the patient's and the doctor's information can call. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information. |
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Supply
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30 day supply |
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Ship To
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Either Doctor's office or Patient's home |
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Note
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The patient is given 25%-100% assistance for up to one year. Negative decision may be appealed. |
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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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| Matulane (procarbazine HCL) |
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