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Patient Assistance Information

 
1 Program for Myfortic tablet; delayed release
 
 
Novartis Patient Assistance Foundation, Inc.

PO Box 52029
Phoenix, AZ 85072
Phone : 800-277-2254
Fax: 855-817-2711
Eligibility
> This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors must complete a portion of the application, sign and attach a prescription for 90 days. Patients must complete a portion of the application, sign and attach a copy of proof of income.
Supply
> Varies
Ship To
> Doctor's office or patient is sent card to be used at pharmacy.
Note
> For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician.
 
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.
 
Myfortic tablet; delayed release
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
(Requires Acrobat Reader