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NitroMed Cares Uninsured Patient Program
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PO Box 520582
Longwood, FL 32750
Phone
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(888)417-7153
Fax:
(407)641-9566
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Eligibility
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To be accepted into this Patient Assistance Program, a patient must meet the following criteria: Must be a US resident. Must be under the care of a Healthcare Provider who has prescribed BiDil as medically appropriate for the patient. Must be ineligible for any public prescription drug insurance, including Medicare, Medicaid and any other state or Federal prescription drug program. Must lack private prescription drug insurance. |
| Who Can Apply
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Physician's office should call the toll-free number shown above. |
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Required
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Completed application form by Healthcare Provider. |
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Supply
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Up to a 90 day supply, renewable quarterly. |
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Ship To
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Free product mailed to physician's office. |
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Note
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Every 3 months the physician must indicate via email, telephone or mail that the patient is continuing therapy. Physician must reapply for the patient annually. |
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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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| BiDil (isosorbide dinitrate and hydralazine hydrochloride) |
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