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Makena Patient Assistance Program
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Makena Care ConnectionTher-Rx Corporation
9717 Key West Avenue
Rockville, MD 20850
Phone
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800-847-3418
Fax:
800-847-3413
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Eligibility
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Patients must have no insurance, have an FDA-approved diagnosis and be a US resident. Income requirements will be determined on a case by case basis. |
| Who Can Apply
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Doctor must start the application process by sending a referral form to the program. |
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Required
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Doctors must complete a section of the application and sign. Patients must complete a section, sign, and attach a copy of proof of income. |
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Supply
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5 doses |
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Ship To
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Doctor's office or patient's home |
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Note
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Insurance benefits, claims assistance and/or other reimbursement help is offered.
This program also provides copay assistance.
Contact program for Spanish 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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| Makena solution |
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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 |
(Requires Acrobat Reader) 
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