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Patient Assistance Information

 
2 Programs Sponsored By Arbor Pharmaceuticals, LLC. (External Link)
 
 
Arbor Pharmaceuticals Patient Assistance Program

951 Clint Moore Road
Suite A
Boca Raton, FL 33487
Phone : (888)417-7153
Fax: (406)641-9566
Eligibility
> The patient must be uninsured or underinsured. Medicare Part D patients may be eligible if they have been denied or are ineligible for Low Income Subsidy. Patients must have a medically appropriate condition/diagnosis. US Residency is required.
Who Can Apply
> Patients can apply for this program by fax or mail.
Required
> Healthcare Providers must complete and sign a section of the application and attach a prescription. Patients must complete and sign a section, attach proof of income, and include a medical denial letter, if needed.
Supply
> Up to a 90 day supply is provided.
Ship To
> Product is shipped to the doctor's office.
Note
> Application decision will be made within 2 to 4 weeks. Medication is delivered within 5 to 7 business days. Patients must contact the company for refills.
 
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.
 
BiDil tablet
E.E.S. granule; oral
Edarbi tablet
Edarbyclor tablet
EryPed granule; oral
Sotylize oral solution
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Arbor Pharmaceuticals Patient Assistance Program
(Requires Acrobat Reader
 
 
GLIADEL WAFER Patient Assistance

PO Box 259
Acworth, GA 30101
Phone : (866)516-4950 Ext 4
Fax: (866)468-2420
Eligibility
> The patient must have no insurance and be at or below 200% of the Federal Poverty Level. The patient must have a medically appropriate condition/diagnosis and must be a citizen of the US and its Territories and be under the care of a US physician.
Who Can Apply
> Patients can apply for this program by fax or mail.
Required
> Healthcare Providers must complete and sign a section of the application and attach a prescription. Patients must complete and sign a section, attach proof of income and any insurance information.
Supply
> 1 box (includes 8 wafers)
Ship To
> The product is shipped to the hospital.
Note
> Application decision will be made within 2 weeks. The product is delivered within 2 to 4 business days. Patients must contact the company for refills.
 
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.
 
Gliadel wafer: polifeprosan 20 with carmustine implant
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Arbor Pharmaceuticals Patient Assistance Program for Gliadel
(Requires Acrobat Reader