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Patient Assistance Information

 
 
 
Pertzye Assistance Program


1120 Win Drive
Bethlehem, PA 18017
Phone : 610-882-5950
Fax: 610-882-0349
Eligibility
> Insurance is determined case by case. Medicare Part D patients are not eligible for this program. Income requirements are determined case by case. US residency not specified.
Who Can Apply
> Doctor/Doctor's office must call and have application faxed to the office. Application is returned via fax. Doctor will be notified of decision.
Required
> Doctors and patients must complete and sign the application.
Supply
> Up to 3 month supply. New application process required for refills. Refill limit not specified.
Ship To
> Medication shipped to Doctor's office within 5-7 business days.
Note
> **Physicians apply for this program on behalf of their patients. Each applicant is looked at on a case by case basis. If another supply is needed, the physician is to submit another enrollment form. This program also provides copay assistance and has a Nutritional Rebate Program.
 
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.
 
Pertzye capsule; delayed release