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Patient Assistance Information

 
2 Programs for Androgel Pump
 
 
AbbVie Patient Assistance Foundation (AndroGel & Creon)

PO Box 270
Somerville, NJ 08876
Phone : (800)222-6885
Fax: (800)276-9901
Eligibility
> This program is intended for patients that have no prescription coverage. Medicare PartD patients may be considered on exception basis. Income requirements for this program have not been disclosed. Must be US resident.
Who Can Apply
> Call to have application faxed, mailed or download from website. Return application via fax or mail from Doctor's office. Patient notified in writing of decision within 7-10 business days.
Required
> Diagnosis/Medical Criteria not specified. Doctor must complete application, sign and attach prescription. Patient must complete application, sign and attach copy of proof of income.
Supply
> Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application, new documentation must be completed yearly.
Ship To
> Ship to Doctor's office or patient's home.
Note
> Exceptions to guidelines considered.
 
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.
 
Androgel Pump
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form AbbVie Patient Assistance Foundation for Androgel and Creon
(Requires Acrobat Reader
 
 
Solvay Pharmaceuticals Patient Assistance Program

C/O Express Scripts Speciality Distribution Svc.
PO Box 66550
St. Louis, MO 63166-6550
Phone : 800-256-8918
Fax: 800-276-9901
Eligibility
> The patient must have no prescription insurance. meet income guidelines that are not disclosed. The patient must also be a US resident. If a patient did not enroll in Medicare Part D, then s/he may still be eligible for this program and should apply. If a patient has Part D and has been denied coverage for Estrates, they may be considered by this program.
Who Can Apply
> With the patient's permission, anyone concerned can 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 must contact the company for refills. Once a year a new application with financial documentation is needed.
 
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.
 
Androgel Pump
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader