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Merck Connect
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,
Phone
:
800-489-5119
Fax:
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Eligibility
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This program is for healthcare professionals only. Patient eligibility will be determined on a case by case basis. Income requirements for this program have not been disclosed. The medication must be medically necessary as determined by a doctor. The patient must be treated by a US licensed healthcare professional. |
Who Can Apply
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Patients can enroll online. |
Required
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Doctors must enroll in the program. Patients must inform their doctor that they are in need. |
Supply
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Up to a 30 day supply. |
Ship To
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Not specified |
Note
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Resources for HEALTHCARE PROFESSIONALS ONLY.
The Physician must register to access tools and materials for patient support, product sample requests, up-to-date professional resources, and other Merck professional sites. |
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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. |
Asmanex Twisthaler Inhalation Powder |
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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. |
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. |
Supply
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Ship To
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Hospital |
Note
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Someone from the hospital must 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. |
Asmanex Twisthaler Inhalation Powder |
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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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SP-Cares
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PO Box 52122
Phoenix, AZ 85072
Phone
:
800-656-9485
Ext OPT 1
Fax:
800-995-9620
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Eligibility
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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
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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. |
Supply
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Up to a 90-day supply |
Ship To
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Doctor's office |
Note
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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. |
Asmanex Twisthaler Inhalation Powder |
|
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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