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Patient Assistance Information

 
1 Program for Angeliq Tablets
 
 
Bayer Patient Assistance Program

6 West Belt
W66
Wayne, NJ 07470-6806
Phone : 888-842-2937 Ext OPT 7 or 3
Fax: 973-305-3545
Eligibility
> The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. The patient must be a US citizen or legal US resident.
Who Can Apply
> The patient or doctor should 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 should 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.
 
Angeliq Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
Download printable Form Angeliq Form
Download printable Form Climara Form
Download printable Form Climara Pro Form
(Requires Acrobat Reader