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Patient Assistance Information

 
2 Programs for Cuprimine Capsules
 
 
Aton Pharma Patient Assistance Program

C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone : 877-286-6549 Ext OPT 3
Fax:
Eligibility
> The patient must have no prescription coverage, have reached his/her cap or cannot afford the co-payments and meet income guidelines that are not disclosed.
Who Can Apply
> The patient or doctor needs to call for a prescreening.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application.
Supply
>
Ship To
> Doctor's office
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.
 
Cuprimine Capsules
 
 
 
Coverage Plus Program

PO Box 220667
Charlotte, NC 28222
Phone : (888)607-7267
Fax: (855)735-4624
Eligibility
> Patients must have no prescription coverage including Medicare Part D, meet income requirements that have not been disclosed and reside in the US, Puerto Rico or the USVI.
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, sign and attach a prescription. Patients must also complete a section, sign and attach required documents. The application must then be faxed or mailed from the doctor's office.
Supply
> Not specified
Ship To
> Patient's home
Note
> This program also provides copay assistance.
 
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.
 
Cuprimine Capsules
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader