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to Pharmaceutical Company
Medication Assistance Programs
Amgen:
Safety net® Program for Neupogen®
SAFETY NET ®
Program for NEUPOGEN®
Products covered by program: NEUPOGEN® ( Filgrastim ) Program is
designed to assist those patients who are medically indigent
(patients may be uninsured or underinsured). Eligibility is based on
patient's insurance status and income level. To enroll a patient,
providers should contact the Amgen SAFETY NET® Program by calling
(800) 272-9376.
Bayer
Indigent Patient Program
Bayer Indigent
Patient Program
Products covered by program: Most Bayer pharmaceutical prescription
medications used as recommended in prescribing information Physician
Requests Should Be Directed To Bayer Indigent Program
P. O. Box 29209 Phoenix, Arizona 85038-9209 (800) 998-9180
Boehringer
Ingelheim Cares Foundation
Boehringer
Ingelheim Cares Foundation, Inc.
Physician requests should be directed to:
Boehringer Ingelheim Cares Foundation, Inc.
c/o Express Scripts Specialty Distribution Services, Inc.
PO Box 66555
St. Louis, MO 63166-6555
800-556-8317 (phone)
Product(s) covered by program:
AGGRENOX®
ATROVENT®,
CATAPRES-TTS®,
COMBIVENT®,
FLOMAX®,
MICARDIS®,
MICARDIS HCT®,
MIRAPEX®,
MOBIC®,
SPIRIVA®,
VIRAMUNE®
Eligibility to be determined solely by BIPI. Patient must be a U.S.
citizen or legal resident ineligible for prescription drug
assistance through Medicaid or private insurance. Patient must meet
established financial criteria.
Other Information:
All requests are reviewed and approved on a case-by-case basis.
Application form, prescription, and patient's income documentation
are required. Maximum of three-month supply may be provided per
request. Complete financial re-application is required annually.
Renewal requests within the same year require only the application
form and a prescription. Program is subject to change without
notice. Current program specifics can be obtained by calling (800)
556-8317 or by contacting www.RxHope.com or www.helpingpatients.org.
Bristol-Myers
Squibb Patient Assistance Program
Bristol-Myers
Squibb Patient Assistance Program
Products covered by program: Many Bristol-Myers Squibb
pharmaceutical products Physician requests should be directed to
Bristol-Myers Squibb Patient Assistance Program P.O. Box 4500
Princeton, New Jersey 08543-2500 Mailcode P25-31 (800) 332-2056;
(609) 897-6859 (fax)
Eligibility: This program is designed to provide temporary
assistance to patients with a financial hardship who are not
eligible for prescription drug coverage through Medicaid or any
other public or private health program.
DuPont Merck
Pharmaceutical Company Patient Assistance Program
DuPont Merck
Pharmaceutical Company Patient Assistance Program
Products covered by program: All marketed non-controlled
prescription Physician requests should be directed to Michelle
Paoli, Du Pont Merck Pharmaceutical Company
P. O. Box 80723 Wilmington, Delaware 19880-0723 (800) 474-2762
Eligibility is based on the patient's insurance status and income
level/assets. Patients should have exhausted all third-party
insurance, Medicaid, Medicare, and all other available programs
Genentech:
Uninsured Patient Assistance Program of Genentech
Uninsured
Patient Assistance Program of Genentech
Products covered by program: Actimmune® (interferon gamma-lb),
Activase® (alteplase recombinant), Protropin® (somatrem for
injection), Nutropin® (somatropin for injection), Nutropin AQ® (somatropin
for injection), Rituxan® (rituximab)
Physician requests should be directed to Genentech, Inc. P. O. Box
2586 Mail Stop #13 S. San Francisco, California 94083-2586 (800)
879-2747, (415) 225-1366 (fax)
Genetics
Institute: Neumega® Access Program
Neumega ® Access
Program (Genetics Institute inc.)
Product covered by program: Neumega ® (oprelvekin) Physician
requests should be directed to The Neumega ® Access Program (888)
NEUMEGA (638-6342) Eligibility: For uninsured and underinsured
patients who have limited financial resources.
Glaxo Wellcome Patient Assistance Program
Glaxo Wellcome
Patient Assistance Program
Products covered by program: All marketed Glaxo Wellcome
prescription products Physician requests should be directed to Glaxo
Wellcome Inc. Patient Assistance Program P. O. Box 52185 Phoenix,
Arizona 85072-2185 (800) 722-9294 (800) 750-9832 (fax) Additional
Program Information Can be found at Helix.com www.Helix.com
Eligibility: Glaxo Wellcome is dedicated to assuring that no one is
denied access to our marketed prescription products as a result of
their inability to pay.
Hoechst Marion Roussel Indigent Patient Program
Hoechst Marion
Roussel Indigent Patient Program
Products covered by program: All prescription products manufactured
by Hoechst Marion Roussel, except Rifadin, Rifamate, Rifater,
Tenuate Anzemet is covered by another program. Physician requests
should be directed to Indigent Patient Program, Hoechst Marion
Roussel, Inc. P. O. Box 9950 Kansas City, Missouri 64134-0950 (800)
221-2025
The Anzemet Patient Assistance Program and the Anzemet
Reimbursement Program (HMR)
Physician requests should be directed to Anzemet Patient Assistance
Program c/o Comprehensive Reimbursement Consultants (CRC) 8990
Springbrook Drive, Suite 200 Minneapolis, Minnesota 55433 (888)
259-2219
Janssen Patient
Assistance Program
Janssen Patient
Assistance Program
Products covered by program: Janssen's medical prescription products
[Duragesic ® (fentanyl transdermal), Ergamisol® (levamisole),
Imodium ® (loperamide), Nizoral ® Cream( ketaconazole cream),
Nizoral® Shampoo ( ketaconazole shampoo), Nizoral ® Tablet (
ketaconazole tablet), Propulsid ® (cisapride), Sporanox ® (
itraconazole), Vermox ® (mebendazole) Physician requests should be
directed to Janssen Patient Assistance Program 1800 Robert Fulton
Drive Reston, Virginia 22091-2346 (800) 544-2987
Lilley Cares
Program
Gemzar
® Patient
Assistance Program
Lilley Cares
Program
Products covered by program: Most Lilley prescription products and
insulins (except controlled substances). Gemzar ® is covered under a
separate program. Physician requests should be directed to Lilley
Cares Program Administrator, Eli Lilley and Company P. O. Box 25768
Alexandria, Virginia 22313, (800) 545-6962
Gemzar
® Patient
Assistance Program
Product covered by program Gemzar ® (gemcitabine hydrochloride)
Physician requests should be directed to Gemzar ® Reimbursement
Hotline (888) 4-GEMZAR (888-243-6927)
Financial Assistance Program for ABELCET
®
Product covered by program ABELCET ® (amphotericin B lipid complex
injection) Physician requests should be directed to Financial
Assistance Program for ABELCET ® The Liposome Company, Inc. One
Research Way, Princeton, New Jersey 08540-6619 (800) 335-5476
The Merck
Patient Assistance Program
The Merck
Patient Assistance Program
Products covered by program: Most Merck products. Requests for
vaccines and injectables are not accepted, with the exception of
requests for anti-cancer injectable products. Physician requests
should be directed to The Merck Patient Assistance Program -- Health
care professionals with prescribing privileges may call (800)
994-2111
Novartis Patient Assistance Program
Novartis Patient
Assistance Program
Products covered by program: Certain single source and/or
life-sustaining products. Controlled substances are not included.
Physician requests should be directed to Novartis Pharmaceuticals
Patient Assistance Program P. O. Box 52052 Phoenix, Arizona
85072-9170 (800) 257-3273
Ortho Biotech
Procrit Line
Procrit Line
Ortho Biotech
Products covered by program: Procrit® (Epoetin alfa) for
non-dialysis use, LEUSTATIN ® (cladribine) Injection Physician
requests should be directed to Ortho Biotech Procrit Line (800)
553-3851 or
http://www.procrit.com
Parke-Davis
Patient Assistance Program
Parke-Davis
Patient Assistance Program
Products covered by program Accupril, Cognex, Dilantin, Loestrin,
Neurontin, Rezulin, and Zarontin Physician requests should be
directed to The Parke-Davis Patient Assistance Program P. O. Box
1058 Somerville, New Jersey 08876 (908) 725-1247
Pfizer
Prescription Assistance
Diflucan®
and Zithromax® Patient Assistance Program
Sharing the Care Program
Pfizer
Prescription Assistance
Products covered by program: Most Pfizer outpatient products with
chronic indications are covered by this program. Diflucan ® and
Zithromax ® are covered by a separate program. Physician requests
should be directed to Pfizer Prescription Assistance P.O. Box 25457
Alexandria, Virginia 22313-5457 (800) 646-2455
Diflucan
® and Zithromax
® Patient Assistance Program
Products covered by program Diflucan ® (fluconazole) and Zithromax ®
(azithromycin) Physician requests should be directed to Diflucan ®
and Zithromax ® Patient Assistance Program (800) 869-9979
Sharing the Care Program
Products covered by program: Certain Pfizer single-source products
Requests should be directed to Sharing the Care Program, Pfizer Inc,
235 E. 42nd Street New York, New York 10017-5755 (800) 984-1500
Pharmacia&
Upjohn RxMAP Prescription Medication Assistance Program
RxMAP
Prescription Medication Assistance Program (PHARMACIA & UPJOHN)
Products covered by program: Numerous Pharmacia&UpJohn products
Physician requests should be directed to RxMAP, P. O. Box 29043,
Phoenix, Arizona 85038 (800) 242-7014
Procter& Gamble
Pharmaceuticals
Procter & Gamble
Pharmaceuticals
Products covered by program: Alora, Asacol, Dantrium Capsules,
Didronel, Helidac, Macrodantin, Macrobid Physician requests should
be directed to Procter & Gamble Pharmaceuticals, Inc. P. O. Box 231
Norwich, New York 13815 Attn: Customer Service Department (800)
448-2878
Rhone-Poulenc Rorer Patient Assistance Program
Rhone-Poulenc
Rorer Patient Assistance Program
Products covered by program: All products are included, with some
limitations Physician requests should be directed to Medical Affairs
/ Patient Assistance Program Rhone-Poulenc Rorer Inc. P. O. Box
5094, 500 Arcola Road Mailstop #4C29 Collegeville, Pennsylvania
19426-0998 (610) 454-8110, (610) 454-2102 (fax)
Roche Medical
Needs Program
Roche Medical
Needs Program
Products covered by program: Roche product line with some exceptions
Physician requests should be directed to Roche Medical Needs Program
Roche Laboratories, Inc. 340 Kingsland Street Nutley, New Jersey
07110 (800) 285-2484
Roche Medical Needs Program for Roferon
® -A (Interferon
alpha-2a, recombinant), Vesanoid ® (tretinoin),and Fluorouracil
Injection
Physician requests should be directed to Oncoline?/Hepline?
Reimbursement Hotline (800) 443-6676 (press 2 or 3)
Roxane
Laboratories Patient Assistance Program
Roxane
Laboratories Patient Assistance Program
Products covered by program: Duraclon; Marinol ® (dronabinol)
Capsules 2.5 mg; Oramorph SR ® (morphine sulfate sustained release)
Tablets, 15 mg, 30 mg, 60 mg, and 100 mg; Roxanol® (morphine sulfate
concentrated oral solution) 20 mg/mL and 120 mL bottles; Roxanol
100® (morphine sulfate concentrated oral solution) 100 mg/5 mL and
240 mL bottles; Roxicodone (oxycodone) Tablets 5 mg; Oral solution 5
mg/5 mL; Roxicodone Intensol® 20 mg/mL; Viramune ® (nevirapine)
Physician requests should be directed to Nexus Healthcare, 4161
Arlingate Plaza, Columbus, Ohio 43228 (800) 274-8651
Sanofi Needy
Patient Program
Sanofi Needy
Patient Program
Products covered by program: Aralen ®, Breonesin ®, Danocrine ®,
Drisdol ®, Hytakerol ®, Mytelase ®, NegGram ®, pHisoHex ®, Plaquenil
®, Primaquine ®, Skelid ®, Photofrin ®, Primacor® Physician requests
should be directed to Sanofi Pharmaceuticals Needy Patient Program
c/o Product Information Department 90 Park Avenue, New York, New
York 10016, (800) 446-6267,
Schering
Laboratories Key Pharmaceuticals Commitment to Care Program
Schering
Laboratories Key Pharmaceuticals Commitment to Care Program
Products covered by program: Most Schering/Key prescription drugs.
Physician requests should be directed to: For Intron A/Eulexin:
(800) 521-7157 For Other Products: Schering Laboratories/ Key
Pharmaceuticals Patient Assistance Program, P. O. Box 52122,
Phoenix, Arizona 85072, (800) 656-9485,
Searle Patients
in Need®Foundation
Searle Patients
in Need ® Foundation
Products covered by program: Aldactazide ®, Aldactone ®, Calan® SR,
Kerlone ®, Calan ®, Covera-HS®, Norpace ®, Norpace ® CR, Cytotec ®,
Physician requests should be directed to Administrator, Searle
Patients in Need ® Foundation, 5200 Old Orchard Road, Skokie,
Illinois 60077, (800) 542-2526, (847) 470-6633 (fax). Or local
Searle Sales Representative
SmithKline
Beecham Access to Care Program
SmithKline
Beecham Access to Care Program
Products covered by program: Most SmithKline Beecham outpatient
prescription products are covered. Controlled substances and
vaccines are not covered. Kytril, Hycamtin and Paxil are covered
under separate Access to Care programs. (See listings.) Physician
requests should be directed to Access to Care Program, SmithKline
Beecham, One Franklin Plaza-FPl320, Philadelphia, Pennsylvania
19101, (800) 546-0420
SmithKline Beecham Oncology Access to Care Program
Products covered by program: Kytril (granisetron HCl) and Hycamtin
(topotecan HCl) Physician requests should be directed to The
Oncology Access to Care Hotline (800) 699-3806
3M
Pharmaceuticals Indigent Patient Pharmaceutical Program
3M
Pharmaceuticals Indigent Patient Pharmaceutical Program
Products covered by program: Most drug products sold by 3M Physician
requests should be directed to Medical Services Department,
275-2E-13, 3M Center, P.O. Box 33275, St. Paul, Minnesota
55133-3275, (800) 328-0255, (612) 733-6068 (fax)
Wyeth-Ayerst
Laboratories Indigent Patient Program
Wyeth-Ayerst
Laboratories Indigent Patient Program
Products covered by program: Various products (not including
scheduleII, III, or IV products) Physician requests should be
directed to John E. James, Professional Services IPP, 555 E.
Lancaster Avenue, St. Davids, Pennsylvania 19087,
Zeneca
Pharmaceuticals Foundation Patient Assistance Program
Zeneca
Pharmaceuticals Foundation Patient Assistance Program
Products covered by program: Accolate®, Arimidex®, Casodex®, Kadian®,
Nolvadex®, Seroquel®, Sorbitrate®, Sular®, Tenoretic®, Tenormin®,
Zestril®, Zoladex®, Zomig®. Physician requests should be directed to
Patient Assistance Program, Zeneca Pharmaceuticals Foundation P.O.
Box 15197, Wilmington, Delaware 19850-5197. (800) 424-3727
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