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Northera Support Center
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Phone
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844-601-0101
Fax:
844-601-0102
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Eligibility
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Northera Support Center provides medication at low or no cost and is intended for patients that do not have prescription coverage for the needed medication. Medicare Part D patients are not eligible. Income requirements for this program have not been disclosed. Patients must have an FDA-approved diagnosis and must be a US resident. |
| Who Can Apply
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Doctor or doctor's office must call. |
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Required
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Patients must inform the doctor that they are in need. The doctor or doctor's office must call and download form from the link below. Doctor's must complete and sign the application and fax back with any necessary documents. Re-applications are determined on a case by case basis. |
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Supply
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As prescribed by the doctor. The company will contact the patient to arrange refills. |
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Ship To
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Patient's home |
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Note
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This program also provides copay assistance. |
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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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| Northera capsule |
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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 |
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
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