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Patient Assistance Information

 
2 Programs Sponsored By Ascend Therapeutics (External Link)
 
 
Ascend Therapeutics Patient Assistance Program

PO Box 2092
Morrisville, PA 19067-9608
Phone : 877-204-1013
Fax:
Eligibility
> This program is based on guidelines that are not disclosed. The patient must also be a US resident.
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
> A voucher is sent to the patient's home.
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.
 
EstroGel
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Aton Pharma Patient Assistance Program

C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone : 877-286-6549 Ext OPT 3
Fax:
Eligibility
> The patient must have no prescription coverage, have reached his/her cap or cannot afford the co-payments 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 and sign the application.
Supply
>
Ship To
> Doctor's office
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.
 
Cuprimine Capsules
Demser Capsules (metyrosine)
Edecrin (ethacrynic acid)
Lacrisert Ophthalmic Insert
Mephyton Tablets (phytonadione)
Syprine Tablets (trientine HCL)