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Patient Assistance Information

 
1 Program for QNASL aerosol; nasal
 
 
TEVACares Foundation Patient Assistance Program

PO Box 52028
Phoenix, AZ 85072
Phone : 877-237-4881
Fax: 877-438-4404
Eligibility
> Patients must have no prescription coverage for the needed medication, including Medicare Part D. Income requirements for this program are based on the Federal Poverty Level. Patients must be a citizen or US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income.
Supply
> Varies
Ship To
> Doctor's office or patient's home
Note
> The CephalonCares Foundation Patient Assistance Program for Fentora, Gabitril, Nuvigil and Tev-Tropin and the TEVA Assistance Program are now known as the TEVA Cares Foundation Patient Assistance Program. 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.
 
QNASL aerosol; nasal
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader