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Patient Assistance Information

 
 
 
Matulane Patient Assistance Program

Matulane Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone : 855-653-3220
Fax: 203-349-3282
Eligibility
> The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. Patient must also have a diagnosis of Stage III or IV Hodgkin's Disease or have another lymphoma where a physician feels a response is possible.The patient must also be a US resident.
Who Can Apply
> Anyone with the patient's and the doctor's information can call.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Supply
> 30 day supply
Ship To
> Either Doctor's office or Patient's home
Note
> The patient is given 25%-100% assistance for up to one year. Negative decision may be appealed.
 
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.
 
Matulane (procarbazine HCL)