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Gelnique Patient Assistance Program
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PO Box 1265
San Bruno, CA 94066
Phone
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(855)217-1616
Fax:
(855)888-7210
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Eligibility
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Patients must have no prescription coverage for the needed medication. They must have an FDA-approved diagnosis and be a US citizen or legal resident. Patients with Medicare Part D may be eligible if the medication is not covered. |
| Who Can Apply
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Patients or healthcare providers must call to obtain an application. |
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Required
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Patients and healthcare providers must complete and sign a section of the application. |
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Supply
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A 90 day supply will be provided. |
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Ship To
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The medication is shipped to the healthcare providers office. |
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Note
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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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| Gelnique Gel 3%, 10% (oxybutynin chloride) |
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