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Patient Assistance Information

 
3 Programs for Avelox Tablets
 
 
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.
 
Avelox Tablets
 
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.
 
Avelox Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
SP-Cares

PO Box 52122
Phoenix, AZ 85072
Phone : 800-656-9485 Ext OPT 1
Fax: 800-995-9620
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
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
> Anyone requesting assistance can call to request a faxed application or download it from the website.
 
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.
 
Avelox Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader