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Patient Assistance Information

Bradley Pharmaceuticals Patient Assistance Program

383 Route 3 West
Fairfield, NJ 07004
Phone : (800) 929-9300 Ext 584
> Eligibility is based on income and lack of third party prescription coverage.
Who Can Apply
> Application information is taken over the phone.
> Caller must provide complete physician information (including DEA, State License, phone and fax numbers) as well as complete patient information.
> 90 days.
Ship To
> Physician's office.
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.
Anamantle HC (lidocaine HCl & hydrocortisone acetate)
Carmol 40 Cream (40% urea)
Carmol 40 Gel (40% urea)
Carmol 40 Lotion (40% urea)
Carmol HC (hydrocortisone acetate, USP)
Carmol Lotion (10% sulfacetamide sodium, USP)
Deconamine (chlopheniramine maleate & pseudphedrine HCl)
Deconamine SR (chlopheniramine maleate & pseudphedrine HCl)
Glutofac-MX (multimineral w/ iron)
Glutofac-ZX (multivitamin & multimineral w/ folic acid & zinc))
LidaMantle Cream (lidocaine HCl)
LidaMantle HC Cream (lidocaine HCl & hydrocortisone acetate)
LidaMantle HC Lotion (lidocaine HCl & hydrocortisone acetate)
LidaMantle Lotion (lidocaine HCl)
Pamine (methscopolamine BR)
Pamine Forte (methscopolamine BR)
Rosula (sodium sulfacetamide & sulfur)
Tyzine (tetrahydrozoline HCl)
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Application Form
(Requires Acrobat Reader