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Orbactiv Support Program
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PO Box 4280
Gaithersburg, MD 20855
Phone
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844-672-2284
Fax:
855-886-2482
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Eligibility
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Orbactiv Support Program provides brand name medications at no or low cost. Patients must be uninsured to be eligible. Income requirements have not been disclosed. |
| Who Can Apply
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Doctors or doctor's offices can call or download the application. |
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Required
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Patients must inform their doctor that they are in need. The application must be completed and signed by the doctor and be faxed or mailed from the doctor's office. |
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Supply
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Not specified |
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Ship To
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Doctor's office or specific site |
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Note
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Resources for HEALTHCARE PROFESSIONALS ONLY. |
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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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| Orbactiv |
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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 |
(Requires Acrobat Reader) 
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