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Patient Assistance Information

 
1 Program for Noritate Cream
 
 
Dermik Patient Assistance Program

PO Box 651
Somerville, NJ 08876
Phone : (866)268-7326
Fax: (866)910-9024
Eligibility
> The patient must be a legal resident of the United States. The patient cannot have or qualify for any government prescription coverage such as Medicare, Medicaid, Veteran's Admistration, or any state or local programs. Patient cannot have or qualify for any private prescription coverage such as an HMO or PPO. Patient's total annual household income must be at or below 200% of the Federal Poverty Guidelines.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The doctor and patient must complete and sign the application. Proof of Income and an original prescription are also required.
Supply
> Up to a 90-day supply
Ship To
> Doctor's office
Note
> Please allow 4 weeks for processing and for delivery of medication to the practitioner’s office for approved patients.
 
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.
 
Noritate Cream
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader