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Patient Assistance Information

 
2 Programs for Orap (pimozide)
 
 
Gate Patient Assistance Program

OpenGATE MedAssist Program
1090 Horsham Rd
North Wales, PA 19454
Phone : (800) 292-4283 Ext 3405
Fax: (215) 653-0839
Eligibility
> Patients must not be eligible for other sources of drug coverage and must be deemed financially eligible based on company guidelines.
Who Can Apply
> Physician's office must call on patient's behalf.
Required
> Signed and completed application, patient proof of income and a prescription for a 90 day supply of medication with up to 3 refills are required.
Supply
> 3 month supply
Ship To
> Physician's office.
Note
> Patient must re-apply after one year.
 
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.
 
Orap (pimozide)
 
 
 
TEVACares Foundation Patient Assistance Program

PO Box 52028
Phoenix, AZ 85072
Phone : 877-237-4881
Fax: 877-438-4404
Eligibility
> Patients must have no prescription coverage for the needed medication, including Medicare Part D. Income requirements for this program are based on the Federal Poverty Level. Patients must be a citizen or US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income.
Supply
> Varies
Ship To
> Doctor's office or patient's home
Note
> The CephalonCares Foundation Patient Assistance Program for Fentora, Gabitril, Nuvigil and Tev-Tropin and the TEVA Assistance Program are now known as the TEVA Cares Foundation Patient Assistance Program. Contact program for Spanish application.
 
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.
 
Orap (pimozide)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader