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Patient Assistance Information

 
3 Programs Sponsored By Endo Pharmaceuticals Inc (External Link)
 
 
Endo Patient Assistance Program

PO Box 66761
St. Louis, MO 63166-6761
Phone : 866-824-4747
Fax: 800-889-0353
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below 200% of the FPL. Medicare partD Patient's are eligible if medication is not covered. The patient must also be a US resident.
Who Can Apply
> Call for application to be faxed. Application must be faxed or mailed back to company from Doctor's office. Patient and Doctor will be notified by mail of decision in 5-7 business days.
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. Doctor/Doctor's office must contact company for refills. Refill limit not specified. New application must be completed every 3 months.
Ship To
> Medication is shipped to Doctor's office within 2 weeks.
Note
> No online application available.
 
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.
 
Frova Tablet
 
 
 
Supprelin LA Shares Program

PO box 2910
Phoenix, AZ 85062
Phone : (855)270-0123
Fax: (888)882-4037
Eligibility
> Insurance requirements are determined case by case. Medicare partD patient's are not eligible for this program. Income requirements are not disclosed. Must be a US resident and treated by a US doctor. Patient over the age of 18 are not eligible.
Who Can Apply
> Doctor/Doctor's office must call for faxed application, download application from website or apply online. Application is to be returned via fax. Patient and Doctor will are notified of decision.
Required
> Must have diagnosis of Central Precocious Puberty (CPP). Patient must inform Doctor that he/she is in need of medication and the Doctor's office must complete application.
Supply
> Amount/supply varies. Refill process & limit not specified. Re-application process not specified.
Ship To
> Medication will be shipped to Hospital, medical center, or specialty pharmacy.
Note
> Resources for HEALTHCARE PROFESSIONALS ONLY. The SUPPRELIN LA Support Center Representative will help arrange the services needed to begin therapy.
 
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.
 
Supprelin LA implant; subcutaneous
 
 
 
Nascobal Patient Assistance Program

1267 Professional Parkway
Gainsville, GA 30507
Phone : (800)589-0841
Fax: (855)828-1491
Eligibility
> This program is intended for Patients with no prescription insurance coverage, this includes Medicare partD patients. Income must be at or below 200% of FPL and a US resident. Diagnosis/medical criteria not specified.
Who Can Apply
> Call for fax or mailed application or download from website. Application must be returned from the prescriber's office via fax or mail. Decision will be communicated within 2-3 days.
Required
> Doctor must complete and sign application. Patient must complete application, sign and attach required documents.
Supply
> Amount/supply varies. Copy of application with new signatures and new prescription required for refills. Refill limit not specified. Company contacts patient about reapplying after 6 months.
Ship To
> Medication ships to Doctor's office within 2 days.
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.
 
Nascobal spray; nasal
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Nascobal Patient Assistance Program
(Requires Acrobat Reader