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hHyalgan Reimbursement Services and Patient Assistance Program
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PO Box 5817
Louisville, KY 40255
Phone
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(866)749-2542
Fax:
(877)366-0584
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Eligibility
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This program is intended for patients with no prescription coverage. Medicare partD patients are eligible if the medication is not covered. Income must be at or below 250% of FPL. Must be a UD citizen or legal resident. |
| Who Can Apply
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Call to have application faxed or download from website. Application must be faxed back to the company. Doctor will be notified within 48hrs of decision. |
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Required
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Must have FDA-approved diagnosis. Doctor must complete and sign application. Patient must complete application, sign and attach insurance information. |
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Supply
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Amount/supply varies. New prescriptions required for each refill. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Medication ships to Doctor's office within 2-3 days. |
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Note
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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.
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| Hyalgan vial |
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