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Medicis Patient Assistance Program
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Patient Assistance Program
Customer Service
Scottsdale, AZ 85258
Phone
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(800) 550-5115
Fax:
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Eligibility
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Eligibility is ddetermined on a case by case basis |
| Who Can Apply
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Physician only |
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Required
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Physician must provide a letter of compelling need and an original prescription. |
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Supply
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Amount determined by physician dependant upon medication needed |
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Ship To
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Physician's office |
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Note
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This is a very informal program and there are no exact income guiddelines for eligibility. |
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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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| A/T/S (erythromycin) |
| Dynacin (Minocycline HCl) |
| Lidex-E (fluocinonide) |
| Loprox (ciclopirox) |
| Lustra (hydroquinone) |
| Lustra-AF (hydroquinone) |
| Novacet (sodium sulfacetamide; sulfur) |
| Ovide (malathion) |
| Synalar (fluocinolone acetonide) |
| Synemol (fluocinolone acetonide) |
| Topicort (desoximetasone) |
| Topicort LP (desoximetasone) |
| Triaz (benzoyl peroxide) |
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Buphenyl Drug Assistance Program
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C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone
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800-711-0811
Fax:
Not Applicable
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Eligibility
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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. The patient must also be a US resident. |
| Who Can Apply
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Anyone with the patient's and the doctor's information can call. |
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Required
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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. |
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Supply
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Ship To
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Doctor's office |
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Note
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Anyone with the patient's and the doctor's information can call. |
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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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| Buphenyl (sodium phenylbutyrate) |
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