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Patient Assistance Information

 
2 Programs for Betapace AF 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.
 
Betapace AF 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
 
 
Berlex Laboratories Patient Assistance Program

Berlex Patient Assistance Program
PO Box 1000 M2/1-5
Montville, NJ 07045
Phone : (888) 237-5394 Ext 6, 1
Fax: (973) 305-3545
Eligibility
> To be accepted into the Berlex Patient Assistance Program, a patient must meet the following criteria:

1) Must be a US citizen

2) Must be ineligible for any public or private health insurance, including Medicare and Medicaid and any other state or private programs and have an annual gross family income of $20,000 or less. (Annual Gross Family Income includes salary, Social Security, disability payments, pension benefits, unemployment, etc. and must include spouse's income if married) or

3) Be eligible for Medicare but ineligible for prescription coverage and must have an annual gross family income of $15,000 or less; and 4) must be under the care of a doctor/prescriber who has prescribed Betapace, Betapace AF, or Climara as medically appropriate for the patient applying for assistance.

Who Can Apply
> Doctor/prescriber's office should call the number above and use option 6, option 1, between 9 a.m. and 5 p.m. EST.
Required
> Income and insurance information are required on the application.
Supply
> Three month supply (Betapace AF is shipped in bottles of 60)
Ship To
> Physician's office
Note
> If the patient is eligible, they will receive up to a three-month supply of medication usually within a week to 10 days. After a year, patient must reapply.
 
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.
 
Betapace AF Tablets