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Patient Assistance Information

 
1 Program for Hylatopic PlusĀ® Cream
 
 
Onset Patient Assistance Program

PO Box 42886
Cincinnati, OH 45242
Phone : (800) 956-0697
Fax: (513)618-0059
Eligibility
> Patient must be a legal resident and ineligible for prescription drug assistance through Medicaid or private insurance. Patient must meet established financial criteria.
Who Can Apply
> Healthcare providers or patients can initiate the application process.
Required
> The application must be completed and signed by both the patient and the healthcare provider. The patient must also sumbit documentation of the gross annual household income.
Supply
> A 30 day supply is shipped for all products.
Ship To
> Medication will be shipped to the Healthcare Provider's office.
Note
> Complete financial re-application is required annually. Renewal requests within the same year require only the application form signed by the healthcare provider.
 
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.
 
Hylatopic PlusĀ® Cream
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader