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Patient Assistance Information

 
 
 
Fentora Reinbursement Program

PO Box 4280
Gaithersburg, MD 20885
Phone : 877-433-6867
Fax: 866-495-0657
Eligibility
> The patient must have no prescription coverage for any medications and meet income guidelines that are not disclosed. The patient must be a US citizen or legal resident.
Who Can Apply
> The patient or doctor needs to call for a prescreening.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to a 90-day supply
Ship To
> Patient's home
Note
> The patient or doctor needs to call for a prescreening.
 
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.
 
Fentora (fentanyl buccal)