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Patient Assistance Information

 
2 Programs for Fentora (fentanyl buccal)
 
 
Fentora Reinbursement Program

PO Box 4280
Gaithersburg, MD 20885
Phone : 877-433-6867
Fax: 866-495-0657
Eligibility
> The patient must have no prescription coverage for any medications and meet income guidelines that are not disclosed. The patient must be a US citizen or legal resident.
Who Can Apply
> The patient or doctor needs to call for a prescreening.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to a 90-day supply
Ship To
> Patient's home
Note
> The patient or doctor needs to call for a prescreening.
 
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.
 
Fentora (fentanyl buccal)
 
 
 
TEVACares Foundation Patient Assistance Program

PO Box 52028
Phoenix, AZ 85072
Phone : 877-237-4881
Fax: 877-438-4404
Eligibility
> Patients must have no prescription coverage for the needed medication, including Medicare Part D. Income requirements for this program are based on the Federal Poverty Level. Patients must be a citizen or US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income.
Supply
> Varies
Ship To
> Doctor's office or patient's home
Note
> The CephalonCares Foundation Patient Assistance Program for Fentora, Gabitril, Nuvigil and Tev-Tropin and the TEVA Assistance Program are now known as the TEVA Cares Foundation Patient Assistance Program. Contact program for Spanish 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.
 
Fentora (fentanyl buccal)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader