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Patient Assistance Information

 
1 Program for Seasonique Tablets
 
 
Seasonique Patient Assistance Program

250 Phillips Blvd
Ste 250
Ewing, NJ 08618
Phone : 800-425-3122
Fax: 800-685-2577
Eligibility
> The patient can have no public or private prescription insurance and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. Patient must be 18 years old or older.
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
> An Extended-Cycle Tablet Dispenser consisting of a 91-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.
 
Seasonique Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader