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Patient Assistance Information

 
 
 
Sandoz One Source Program

P.O. Box 220188
Charlotte, NC 28222
Phone : (844)726-3691
Fax: (844)726-3695
Eligibility
> Patients must have no prescription coverage. Income requirements have not been disclosed. The medication must be determined as medically necessary by a doctor and the patient must be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, and attach required documents.
Supply
> Varies
Ship To
> Not specified
Note
> This program also provides copay assistance.
 
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.
 
Zarxio
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader