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Bayer Patient Assistance Program
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6 West Belt
W66
Wayne, NJ 07470-6806
Phone
:
888-842-2937
Ext OPT 7 or 3
Fax:
973-305-3545
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Eligibility
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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
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The patient or doctor should call for an application. |
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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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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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The patient or doctor should call for an application. |
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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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| Cipro I.V. (ciprofloxacin) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| Download printable Form Angeliq Form |
| Download printable Form Climara Form |
| Download printable Form Climara Pro Form |
(Requires Acrobat Reader) 
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Schering Laboratories Patient Assistance Program
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PO Box 6842
Somerset, NJ 08875
Phone
:
800-656-9485
Ext OPT2
Fax:
Not Applicable
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Eligibility
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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
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Someone from the hospital must call for an application. |
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Required
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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. |
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Supply
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Ship To
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Hospital |
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Note
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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.
|
| Cipro I.V. (ciprofloxacin) |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Application Form |
| (Requires Acrobat Reader)
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