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Patient Assistance Information

 
2 Programs for Locoid® Lotion
 
 
Onset Patient Assistance Program

PO Box 42886
Cincinnati, OH 45242
Phone : (800) 956-0697
Fax: (513)618-0059
Eligibility
> Patient must be a legal resident and ineligible for prescription drug assistance through Medicaid or private insurance. Patient must meet established financial criteria.
Who Can Apply
> Healthcare providers or patients can initiate the application process.
Required
> The application must be completed and signed by both the patient and the healthcare provider. The patient must also sumbit documentation of the gross annual household income.
Supply
> A 30 day supply is shipped for all products.
Ship To
> Medication will be shipped to the Healthcare Provider's office.
Note
> Complete financial re-application is required annually. Renewal requests within the same year require only the application form signed by the healthcare provider.
 
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.
 
Locoid® Lotion
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Patient Access Network Foundation (PAN)

PO Box 221858
Charlotte, NC 28222
Phone : (866)316-7263
Fax: (866)316-7263
Eligibility
> This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US.
Who Can Apply
> Patients or healthcare providers can complete the application online or by phone.
Required
> Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received.
Supply
> Not applicable
Ship To
> Patient sent card to be used at pharmacy
Note
> *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
 
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.
 
Locoid® Lotion
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader