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Patient Assistance Information

 
 
 
Arbor Pharmaceuticals Patient Assistance Program

951 Clint Moore Road
Suite A
Boca Raton, FL 33487
Phone : (888)417-7153
Fax: (406)641-9566
Eligibility
> The patient must be uninsured or underinsured. Medicare Part D patients may be eligible if they have been denied or are ineligible for Low Income Subsidy. Patients must have a medically appropriate condition/diagnosis. US Residency is required.
Who Can Apply
> Patients can apply for this program by fax or mail.
Required
> Healthcare Providers must complete and sign a section of the application and attach a prescription. Patients must complete and sign a section, attach proof of income, and include a medical denial letter, if needed.
Supply
> Up to a 90 day supply is provided.
Ship To
> Product is shipped to the doctor's office.
Note
> Application decision will be made within 2 to 4 weeks. Medication is delivered within 5 to 7 business days. Patients must contact the company for refills.
 
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.
 
BiDil tablet
E.E.S. granule; oral
Edarbi tablet
Edarbyclor tablet
EryPed granule; oral
Sotylize oral solution
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Arbor Pharmaceuticals Patient Assistance Program
(Requires Acrobat Reader