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Solvay Pharmaceuticals Patient Assistance Program
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C/O Express Scripts Speciality Distribution Svc.
PO Box 66550
St. Louis, MO 63166-6550
Phone
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800-256-8918
Fax:
800-276-9901
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Eligibility
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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
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With the patient's permission, anyone concerned can call for an application. |
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Required
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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. |
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Supply
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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed. |
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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.
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| Estratest H.S. Tablets |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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