Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
2 Programs Sponsored By Validus Pharmaceuticals, Inc. (External Link)
 
 
Equetro Patient Assistance Program

119 Cherry Hill Road, Suite 310
Parsippany, NJ 07054
Phone : (866)982-5438
Fax:
Eligibility
> The patient must have no prescription coverage, be at or below 200% of the Federal Poverty Level and be a US citizen.
Who Can Apply
> Anyone requesting assistance can call to have an application faxed or mailed. An application can also be downloaded.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to 3 months supply
Ship To
> Doctor's office
Note
>
 
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.
 
Equetro Extended-Release Capsules
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader
 
 
Marplan Patient Assistance Program

119 Cherry Hill Rd, Suite 310
Parsippany, NJ 07054
Phone : (866)982-5438
Fax:
Eligibility
> Patients must have no prescription coverage, be at or below 200% of the Federal Poverty Level and be a US citizen or legal resident.
Who Can Apply
> Anyone interested can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Doctors must complete a section of the application, sign and attach a prescription. Patients must complete a section, sign and attach a copy of proof of income. The application must then be mailed.
Supply
> Up to 3 months supply
Ship To
> Doctor's office
Note
>
 
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.
 
Marplan tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader