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Patient Assistance Information

 
5 Programs Sponsored By Cephalon, Inc (External Link)
 
 
Gabitril Patient Assistance Program

c/o InTeleCenter
PO Box 4280
Gaithersburg, MD 20885-4280
Phone : 866-209-7589
Fax: 866-209-7596
Eligibility
> The patient must be uninsured and have an income at or below 200% of the Federal Poverty Level. The patient must also be taking the medication for an on-label diagnosis.The patient must also be a US resident.
Who Can Apply
> The doctor/doctor's office must call for a prescreening.
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
> A coupon for 90-day supply
Ship To
>
Note
> The doctor/doctor's office must 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.
 
Gabitril (tiagabine hydrochloride)
 
 
 
Provigil Patient Assistance Program

C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone : 800-675-8415
Fax: 203.798.2964
Eligibility
> The patient must have no insurance and meet income guidelines that are not disclosed.
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, sign the application and attach proof of income.
Supply
> A coupon for 90-day supply
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.
 
Provigil (modafinil)
 
 
 
Cephalon Patient Assistance Program

Gabitril Patient Assistance Program c/o InTeleCenter
P.O. Box 4280
Gaithersburg, MD 20885-4280
Phone : (866) 209-7589
Fax: (866) 209-7596
Eligibility
> Eligibiltiy is based on income, insurance coverage and diagnosis.
Who Can Apply
> Physician's office only
Required
> Proof of income is required
Supply
> Coupon for 90 day supply
Ship To
> Coupon mailed to patient's home and confirmation letter sent to physician
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.
 
Gabitril (tiagabine hydrochloride)
 
 
 
Fentora Reinbursement Program

PO Box 4280
Gaithersburg, MD 20885
Phone : 877-433-6867
Fax: 866-495-0657
Eligibility
> The patient must have no prescription coverage for any medications and meet income guidelines that are not disclosed. The patient must be a US citizen or legal resident.
Who Can Apply
> The patient or doctor needs to 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.
Supply
> Up to a 90-day supply
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.
 
Fentora (fentanyl buccal)
 
 
 
Trisenox Drug Replacement Program

Address: N/A
,
Phone : (866) 261-7730
Fax: (888) 891-4924
Eligibility
> The patient must have no prescription coverage for the medication and meet income guidelines that are not disclosed. The patient must also be a US citizen being treated by a US doctor. A negative decision can be appealed.
Who Can Apply
> The doctor/doctor's office should call for an application. The application will be faxed out. The completed application must be faxed back.
Required
> The doctor must fill out a section and sign the application. The patient must fill out a section and sign the application.
Supply
> n/a
Ship To
> Doctor's office
Note
> Once a year the application process must be repeated.
 
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.
 
Trisenox (arsenic trioxide)