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Patient Assistance Information

Patient Rx Solutions Program - Sancuso

Patient Rx Solutions Sancuso
Patient Assistance Proram PO Box 325
Florham Park, NJ 07932
Phone : 866-325-8231
Fax: 866-694-2546
> This program provides brand name medications at no or low cost to patients that have no prescription coverage for the needed medication. Patients with Medicare Part D are not eligible. Patients must be at or below 300% of the federal poverty level and must be a US citizen or legal resident.
Who Can Apply
> Patients and healthcare providers can call to have an application faxed, mailed or it can be downloaded.
> Doctors must complete a section of the application, sign and attach a prescription. Patients must complete a section of the application, sign and attach proof of income. The application can then be faxed or mailed.
> Varies
Ship To
> Doctor's office
> This Company also offers a Reimbursement Program. SANCUSO Copay Assistance Card Program: Save up to $150 on each prescription after paying the first $20. Each SANCUSO card is good for 24 fills, up to 4 patches per fill up to a maximum of 48 patches, subject to your prescription coverage. 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.
Sancuso transdermal patch
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
(Requires Acrobat Reader