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Patient Assistance Information

 
1 Program for Arestin powder; extended release
 
 
Arestin Rx Access Co-Pay


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Phone : 855-684-7481
Fax: 855-630-9783
Eligibility
> This program is for Healthcare Professionals Only. Patients must have no insurance. Patients must be 18 years old or older and must be treated by a US doctor.
Who Can Apply
> Healthcare providers can call to have an application faxed or download one.
Required
> Doctors must enroll in the program, complete the form and obtain patient consent. Patients must complete a section of the form and sign. The application must then be faxed from the doctor's office.
Supply
> Not specified
Ship To
> Not specified
Note
> Co-Pay Assistance expires 12/31/2016. The offer is only valid for patients with private insurance.
 
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.
 
Arestin powder; extended release
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader