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Patient Assistance Information

 
1 Program for EstratestHS (esterified estrogen; methyltestosterone)
 
 
Solvay Pharmaceuticals Patient Assistance Program

C/O Express Scripts Speciality Distribution Svc.
PO Box 66550
St. Louis, MO 63166-6550
Phone : 800-256-8918
Fax: 800-276-9901
Eligibility
> The patient must have no prescription insurance. meet income guidelines that are not disclosed. The patient must also be a US resident. If a patient did not enroll in Medicare Part D, then s/he may still be eligible for this program and should apply. If a patient has Part D and has been denied coverage for Estrates, they may be considered by this program.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
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
Ship To
> Doctor's office
Note
> The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.
 
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.
 
EstratestHS (esterified estrogen; methyltestosterone)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader