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Patient Assistance Information

 
 
 
Sculptra Patient Access Program

PO Box 430
Somerville, NJ 08876
Phone : (866)310-7551
Fax: (866)364-2016
Eligibility
> Patients must have no prescription coverage for the needed medication, meet income requirements that have not been disclosed, have an FDA-approved diagnosis and must be a US citizen or legal resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed.
Required
> Doctors must complete a section of the application, sign and attach a prescription. Patients must also complete a section of the application, sign, attach proof of income and attach insurance information. The application can then be faxed or mailed.
Supply
> Not specified
Ship To
> Doctor's office
Note
>
 
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.
 
Sculptra Injectable