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Patient Assistance Information

 
5 Programs Sponsored By Bayer HealthCare Pharmaceuticals Inc. (External Link)
 
 
Bayer Patient Assistance Program for Nimotop & Precose

PO Box 29209
Phoenix, AZ 85038-9209
Phone : 800-998-9180 Ext OPT 1
Fax: Not Applicable
Eligibility
> The patient must meet insurance and financial guidelines that are not disclosed. The patient must be a US citizen or legal US resident.
Who Can Apply
> The patient or doctor needs to call for a prescreening.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application.
Supply
> The patient is sent a pharmacy card.
Ship To
> Patient's home
Note
> The patient or doctor needs to call for a prescreening.
 
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.
 
Precose (acarbose)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
REACH (Resources for Expert Assistance and Care Helpline)

PO Box 221289
Charlotte, NC 28222-1289
Phone : 877-322-4448
Fax: 866-639-5181
Eligibility
> The patient may be uninsured or be insured but experiencing difficulty accessing the medications. the patient must also also have limited financial resources.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The doctor must complete the appropriate section and sign the application.The patient must also complete, sign the application and attach proof of income.
Supply
>
Ship To
> Doctor's office
Note
> With the patient's permission, anyone concerned can call for an application.
 
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.
 
Campath
Fludara (fludarabine phosphate)
Leukine (sargramostim)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Betaseron Patient Assistance Program

PO Box 221349
Charlotte, NC 28222-1349
Phone : 877-836-5724
Fax: 877-744-5615
Eligibility
> The patient must meet insurance and financial guidelines that are not disclosed. The patient must also have MS.The patient must also be a US resident.
Who Can Apply
> The doctor or patient can call to request an application.
Required
> The doctor needs to complete an application, sign it and attach a prescription.The patient needs to complete an application, sign it, and attach proof of income and other requested documentation.
Supply
> A 90-day supply
Ship To
> Patient's home
Note
> The doctor or patient can call to request an application.
 
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.
 
Betaseron (interferon beta-1b)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Bayer Patient Assistance Program

6 West Belt
W66
Wayne, NJ 07470-6806
Phone : 888-842-2937 Ext OPT 7 or 3
Fax: 973-305-3545
Eligibility
> The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. The patient must be a US citizen or legal US resident.
Who Can Apply
> The patient or doctor should call for an application.
Required
> 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.
Supply
> Up to a 90-day supply
Ship To
> Doctor's office
Note
> The patient or doctor should call for an application.
 
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.
 
Adalat CC (Nifedipine)
Angeliq Tablets
Avelox Tablets
Betapace AF Tablets
Biltricide (praziquantel)
Cipro HC Ophthalmic Solution
Cipro I.V. (ciprofloxacin)
Climara Pro transdermal
Climara transdermal
DTIC-Dome (decarbazine)
Precose (acarbose)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
Download printable Form Angeliq Form
Download printable Form Climara Form
Download printable Form Climara Pro Form
(Requires Acrobat Reader
 
 
Nexavar Reach Program

PO Box 220765
, NC 28222-0765
Phone : 877-322-4448
Fax: 866-639-5181
Eligibility
> The patient must have no prescription coverage for the requested medication and meet income and other eligibility guidelines that are not disclosed.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> 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.
Supply
>
Ship To
> Patient's home
Note
> Anyone requesting assistance can call to request a faxed application or download it from the website.
 
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.
 
Nexavar
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
Download printable Form Spanish Version
(Requires Acrobat Reader