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Cayston Patient Assistance Program
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po bOX 13185
La Jolla, CA 92039
Phone
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(877)722-9786
Fax:
(877)550-1705
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Eligibility
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This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Income based on FPL. Must be a US resident. |
Who Can Apply
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Call to have application faxed or mailed. Return application via fax or mail. Patient must complete application, sign and attach proof of income. |
Required
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Medically appropriate condition/diagnosis required. Doctor must complete and sign application. |
Supply
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Up to 1 month supply. Patient contacts pharmacy. Refill limit not specified. Re-application process not specified. Patient and Doctor notified in writing of decision in 3-5 business days. |
Ship To
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Ships to Patient's home, unless otherwise noted within 2 business days. |
Note
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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. |
aztreonam |
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