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Patient Assistance Information

 
1 Program for Makena solution
 
 
Makena Patient Assistance Program

Makena Care ConnectionTher-Rx Corporation
9717 Key West Avenue
Rockville, MD 20850
Phone : 800-847-3418
Fax: 800-847-3413
Eligibility
> Patients must have no insurance, have an FDA-approved diagnosis and be a US resident. Income requirements will be determined on a case by case basis.
Who Can Apply
> Doctor must start the application process by sending a referral form to the program.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section, sign, and attach a copy of proof of income.
Supply
> 5 doses
Ship To
> Doctor's office or patient's home
Note
> Insurance benefits, claims assistance and/or other reimbursement help is offered. This program also provides copay assistance. 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.
 
Makena solution
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader