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Merck Connect
|
,
Phone
:
800-489-5119
Fax:
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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. |
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Required
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Doctors must enroll in the program. Patients must inform their doctor that they are in need. |
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Supply
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Up to a 30 day supply. |
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Ship To
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Not specified |
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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. |
| |
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
|
PO Box 6842
Somerset, NJ 08875
Phone
:
800-656-9485
Ext OPT2
Fax:
Not Applicable
|
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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. |
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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
|
| > |
|
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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) 
|
| |
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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)
|
| |
|
|