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Seasonique Patient Assistance Program
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250 Phillips Blvd
Ste 250
Ewing, NJ 08618
Phone
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800-425-3122
Fax:
800-685-2577
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Eligibility
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The patient can have no public or private prescription insurance and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. Patient must be 18 years old or older. |
| Who Can Apply
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The patient or doctor should call for an application. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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An Extended-Cycle Tablet Dispenser consisting of a 91-day supply. |
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Ship To
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Doctor's office |
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Note
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The patient or doctor should call for an application. |
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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.
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| Seasonique Tablets |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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