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Patient Assistance Information

 
1 Program for LMX cream; anesthetic
 
 
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.
 
LMX cream; anesthetic
 
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