|
Bayer Patient Assistance Program
|
6 West Belt
W66 Wayne, NJ 07470-6806
Phone
:
888-842-2937
Ext OPT 7 or 3
Fax:
973-305-3545
|
Eligibility
|
> |
The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. The patient must be a US citizen or legal US resident. |
Who Can Apply
|
> |
The patient or doctor should 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 should call for an 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. |
Biltricide (praziquantel) |
|
Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form Application Form |
Download printable Form Angeliq Form |
Download printable Form Climara Form |
Download printable Form Climara Pro Form |
(Requires Acrobat Reader)
|
|
|
|
Schering Laboratories Patient Assistance Program
|
PO Box 6842
Somerset, NJ 08875
Phone
:
800-656-9485
Ext OPT2
Fax:
Not Applicable
|
Eligibility
|
> |
The patient must have no prescription coverage for any medications and have an income at or below 200% of the Federal Poverty Level. This is a hospital replacement program, so the patient must have already received the medication.The patient must also be a US resident. |
Who Can Apply
|
> |
Someone from the hospital must call for an application. |
Required
|
> |
The hospital contact person must fill out and sign the application.The patient must provide information (financial, insurance, and medical) but no signature is required. |
Supply
|
> |
|
Ship To
|
> |
Hospital |
Note
|
> |
Someone from the hospital must call for an 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. |
Biltricide (praziquantel) |
|
Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form Application Form |
(Requires Acrobat Reader)
|
|
|