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Patient Assistance Information

 
3 Programs Sponsored By Sandoz (External Link)
 
 
OmniSource Patient Assistance Program

OmniSource7
420 Goodlett Farms, #110
Memphis, TN 38016
Phone : 877-456-6794
Fax: 877-828-1052
Eligibility
> Patients must be uninsured or underinsured. Income requirements for this program have not been disclosed. The medication must be for a child and the patient must be a US resident or legal entrant.
Who Can Apply
> Doctor or doctor's office must call or download an applicaiton.
Required
> The patient must inform the doctor that they are in need. The hospital or doctor must complete the application and verify patients financial situation.
Supply
> Not specified
Ship To
> Doctor's office
Note
> Patient must have exhausted all appeals before applying to the Patient Assistance Program: Contact the OmniStart Program for details. Resources for HEALTHCARE PROFESSIONAL ONLY. Medications manufactured: Generics.
 
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.
 
Omnitrope injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
(Requires Acrobat Reader
 
 
Omnitrope Save As You Grow Program


,
Phone : 866-557-4046
Fax: 877-828-1052
Eligibility
> Patients may have private insurance but may not have any form of public insurance. Income requirements for this program have not been disclosed. The medication must be for a child and the patient must reside in the US.
Who Can Apply
> The doctor or doctor's office must call for a pre-screening.
Required
> Patients must inform the doctor that they are in need and the doctor must enroll in the program, complete the form and receive patient consent.
Supply
> Not applicable
Ship To
> Card obtained from doctor's office
Note
> Physician must call program to pre-screen patient. Eligible patients may be able to save up to $250 a month for up to 12 months on out-of pocket costs for Omnitrope.
 
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.
 
Omnitrope injection
 
 
 
Sandoz One Source Program

P.O. Box 220188
Charlotte, NC 28222
Phone : (844)726-3691
Fax: (844)726-3695
Eligibility
> Patients must have no prescription coverage. Income requirements have not been disclosed. The medication must be determined as medically necessary by a doctor and the patient must be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, and attach required documents.
Supply
> Varies
Ship To
> Not specified
Note
> This program also provides copay assistance.
 
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.
 
Zarxio
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader