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Patient Assistance Information

 
 
 
Aton Pharma Patient Assistance Program

C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone : 877-286-6549 Ext OPT 3
Fax:
Eligibility
> The patient must have no prescription coverage, have reached his/her cap or cannot afford the co-payments and meet income guidelines that are not disclosed.
Who Can Apply
> The patient or doctor needs to call for a prescreening.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application.
Supply
>
Ship To
> Doctor's office
Note
> The patient or doctor needs to call for a prescreening.
 
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.
 
Cuprimine Capsules
Demser Capsules (metyrosine)
Edecrin (ethacrynic acid)
Lacrisert Ophthalmic Insert
Mephyton Tablets (phytonadione)
Syprine Tablets (trientine HCL)