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Patient Assistance Information

 
4 Programs Sponsored By Sigma-Tau (External Link)
 
 
Carnitor Drug Assistance Program

Carnitor Drug Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone : 855-653-3220
Fax: 203-349-3279
Eligibility
> The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must be diagnosed with Carnitene Definciency, be a US resident and have a prescription from a US doctor.
Who Can Apply
> The doctor, patient, social worker or patient advocate must call for a prescreening.
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 and any insurance information.
Supply
> Up to a 90-day supply
Ship To
> Patient's home
Note
> Assistance may be give from 25-100% for up to 1 year. Negative decision may be appealed.
 
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.
 
Carnitor (levocarnitine)
Carnitor Injection
Carnitor Oral Solution
Carnitor Sugar Free Oral Solution
 
 
 
Matulane Patient Assistance Program

Matulane Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone : 855-653-3220
Fax: 203-349-3282
Eligibility
> 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
> Anyone with the patient's and the doctor's information can call.
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 and any insurance information.
Supply
> 30 day supply
Ship To
> Either Doctor's office or Patient's home
Note
> The patient is given 25%-100% assistance for up to one year. Negative decision may be appealed.
 
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.
 
Matulane (procarbazine HCL)
 
 
 
Sigma-Tau Patient Assistance Program and Reimbursement Services

200 Pinecrest
Morgantown, WV 26050
Phone : 800-490-3262
Fax: 866-694-2544
Eligibility
> Patients must have no coverage for the requested medication and be ineligible for federal or state programs. Patients must be at or below 300% of the Federal Poverty Level.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed, mailed or emailed.
Required
> Doctors must complete a section, sign, attach prescription and include their DEA and state license number. Patients must complete a section, sign, and attach a copy of proof of income.
Supply
> Up to 3 months supply
Ship To
> Doctor's office or infusion site
Note
> Insurance benefits, claims assistance and/or other reimbursement help is offered. Contact program for Spanish 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.
 
Abelcet (amphotericin B lipid complex injection)
Depocyt (cytarabine liposome)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader
 
 
VSL#3 DS Medical Food Patient Assistance Program


,
Phone : 877-279-2459
Fax: 203-349-8172
Eligibility
> Patients must be uninsured, have Ulcerative Colitis or Pouchitis and be a US resident. There are no income limits for this program.
Who Can Apply
> Patients must call to have an application sent to them.
Required
> Doctors and patients must both complete a section and sign.
Supply
> Varies
Ship To
> Patient's home
Note
> The program covers VSL#3 DS packets, not capsules.
 
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.
 
VSL 3 DS concentrated probiotic