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Patient Assistance Information

 
3 Programs for Asmanex Twisthaler Inhalation Powder
 
 
Merck Connect


,
Phone : 800-489-5119
Fax:
Eligibility
> 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
> Patients can enroll online.
Required
> Doctors must enroll in the program. Patients must inform their doctor that they are in need.
Supply
> Up to a 30 day supply.
Ship To
> Not specified
Note
> 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.
 
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
 
 
 
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.
 
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
 
 
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.
 
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