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Patient Assistance Information

 
1 Program for Analpram Advanced Kit cream
 
 
Ferndale Laboratories Patient Assistance Program

Customer Services
780 West Eight Mile Rd.
Ferndale, MI 48220
Phone : 800-621-6003 Ext 421
Fax: 248-548--0279
Eligibility
> The Patient may have insurance, including Medicare partD. Income requirements are based on FPL. Must be a US resident. No diagnosis/medical criteria required.
Who Can Apply
> Call to get application faxed, mailed or emailed, application can be returned via fax, mail or email. Patient will be notified in 7-10 business days.
Required
> Doctor must complete and sign application. Patient must complete application, sign, and attach copy of income.
Supply
> Amount requested is sent. Patient or Doctor must contact company for refills. No refill limit. New application must be completed yearly.
Ship To
> Medication will be shipped to Doctor's office or Patient's home within 7-10 business days.
Note
> Eligibility determined on a case-by-case basis. Contact program for Spanish application.
 
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.
 
Analpram Advanced Kit cream
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Ferndale Laboratories Patient Assistance Program
(Requires Acrobat Reader