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CHAPTER 23

PHARMACEUTICAL ASSISTANCE
PROGRAMS

Many pharmaceutical companies provide prescription medicines free of charge to consumers and to physicians whose patients might not otherwise have access to necessary medicines. Each of the special programs offered by the pharmaceutical companies has its own set of eligibility criteria and specific instructions about making a request for assistance. In many cases, your physician is required to refer you to the pharmaceutical assistance program or to make an application on your behalf. Most of these programs have strict eligibility requirements. Many require that a patient have no health coverage (including Medicaid or “Medigap” insurance). Some companies use income limits to ascertain eligibility. This guide lists some of the drugs available from the different companies. Other drugs may also be available. Talk with your pharmacist or physician to find out which company makes the drug you need. These programs may change at any time. Other programs may also be available. If you need assistance, talk to your doctor. He or she may be able to ask local sales representatives about other programs. In addition, the Pharmaceutical Research and Manufacturers of America (PhRMA) maintains a list of companies with patient assistance programs. Visit the organization’s Web site at http://www.phrma.org for additional information. The following section provides information about the pharmaceutical assistance programs offered by various drug manufacturers. They are listed in alphabetical order by manufacturer. Abbott Laboratories Patient Assistance Program
Product: Most Abbott Laboratories products. Physicians should call for application information. Agouron
Pharmaceuticals

The applicant or physician may contact the program. Applications are mailed to the physician. Eligibility is determined on a case-by-case basis.
Alcon Labs

Ophthalmologists must call on behalf of the patient. The physician must write a letter on the patient’s behalf.
Allergan, Inc.

Products: Alphagan, Betagen, Celluvisc, Propine, Pilagan, Epifrin, Lacri-Lube, Refresh, Refresh Plus, Refresh PM, Tears Plus The physician must send a special request letter on behalf of the patient.
Alza
Pharmaceuticals

Products: BiCitra, Concerta, Ditropan, Elmiron, Mycelex, Neutro-Phos, PolyCitra, Testoderm, Ocusert, Progestasert The physician must request an Indigent Patient Application Kit.
Amarin
Pharmaceuticals

Products: Bontril, Capital and Codein oral suspension, Exgest, Hydrocet, Motofen, Nolahist, Nolamine, Phrenilin, Phrenilin Forte, Salflex The physician must call and complete the application. The patient's income must be below the federal poverty guidelines and the patient may not have any other assistance. Pharmaceutical Assistance Programs Amgen, Inc.
For dialysis patients only. Providers apply on behalf of their patients. For Chronic Hepatitis C patients only. Providers apply on their patients’ behalf. Providers should call for an application.
AstraZeneca
AstraZeneca LP Patient Assistance Program Products: Atacand, Emla, Lexxel, Plendil, Prilosec, Tonocard, Toprol The physician must apply on behalf of the patient. Foscavir Assistance and Information on Reimbursement AstraZeneca Foundation Patient Assistance Program The patient may call for application information. Eligibility is determined on a case-by-case basis.
Aventis Pasteur
Indigent Patient Program (800) VACCINE, (800) 822-2463 Products: Imovax and Imogam rabies vaccine Eligibility is determined on a case-by-case basis. Aventis
Pharmaceuticals

Aventis Pharmaceuticals Patient Assistance Program Patients must have income below the federal poverty guidelines and not have any other coverage. The patient or physician may contact the company.
Bayer Corporation
Pharmaceutical
Division

Bayer Indigent Patient Program (800) 468-0894, Ext. 2765; (800) 998-9180 Products: Most Bayer prescription products The physician or patient can call to determine eligibility. Patients who are eligible for government programs or covered by insurance are not eligible for this program.
Berlex Laboratories Berlex Laboratories
Products: Betapace, Quinaglute Dura-Tabs The enrollment form must be completed by the physician. A short qualification form must be completed by the physician.
Biogen, Inc.

Eligibility is determined based on insurance status and income. The physician should call for information.
Boehringer
Ingleheim
Pharmaceuticals

Products: Aggrenox, Atrovent, Cafcit, Catapres, Combivent, Flomax, Micardis, Mobic, and Viramune Eligibility is determined on a case-by-case basis. Patients who qualify for Medicaid or have other drug coverage are not eligible. Pharmaceutical Assistance Programs Bristol-Myers Squibb
Company

Products: Many Bristol-Myers Squibb pharmaceutical products Physicians or other providers should call the toll-free number above to request an application form.
Centocor, Inc.
The patient or physician may submit an application. The patient must meet financial qualifications. The patient must meet financial criteria. The provider should contact the company and complete an application.
Ciba
Pharmaceuticals

DuPont
Pharmaceuticals
Company

Products: Most non-controlled prescription products The physician should contact the company for application information. Eligibility is based on income and insurance status.
Eisai Inc.
The patient may not have insurance coverage for medications and must also meet income criteria. The patient must meet certain financial criteria. Physicians should call for information. Elan
Pharmaceuticals

Elan Pharmaceuticals Prescription Assistance Program (800) 621-4835 (Physicians and staff only) Products: Permax, Zanaflex, Diastat, Mysoline, Zonegran Patients must meet income criteria and have no third-party coverage. Fujisawa Healthcare Prograf Patient Assistance Program
Patients must have no insurance coverage for medications and must meet financial eligibility criteria. Physicians should call for information. Genentech, Inc.
Products: Activase, Herceptin, Protropin, Nutropin, Rituxin, and TNKase The physician should contact the program. A completed application form including medical, financial, and insurance information must be submitted for consideration. The patient cannot be eligible for other assistance. Three programs can help patients who are uninsured, or can help with the out-of-pocket costs for patients who do have insurance. Assistance is based on a sliding scale. Physicians should contact the company for more information.
Genetics Institute
The Benefix Reimbursement and Information Program
(888) 999-2349 Product: Benefix Coagulation Factor IX The patient must meet certain financial criteria. An application must be completed by the physician and patient. Neumega Access Program (888) NEUMEGA (888-638-6342) Product: Neumega This program is for patients who meet financial eligibility criteria and are uninsured or underinsured. The physician or patient may call for information. Pharmaceutical Assistance Programs Genzyme
Corporation

Eligibility is based on financial need. The patient cannot have other coverage.
Gilead Sciences, Inc.Gilead Sciences Reimbursement Support and Assistance Program
The program can assist both uninsured and insured patients with reimbursement.
GlaxoSmithKline
Glaxo Wellcome Patient Assistance Program Products: All current Glaxo Wellcome products for outpatient use. Eligibility is based on information provided by a physician or advocate regarding the patient’s prescription drug coverage and financial resources. SmithKline Beecham Foundation Access to Care Products: Amoxil, Augmentin, Avandia, Bactroban, Compazine, Coreg, Dyazide, Famvir, Paxil, Relafen, Requip, and Tagamet The patient must meet financial criteria. Assistance may also be available for co-payments for insured patients. The patient and physician must complete the application. The patient or physician should call for more information about this program.
Hoechst Marion
Roussel


Immunex
Corporation

Products: Leukine, Novantrone, Amicar, Thioplex The physician should apply on the patient’s behalf. Eligibility is based on the patient's income and insurance status. The patient cannot be eligible for other assistance.
Janssen
Pharmaceutica

Products: All Janssen prescription products Patients must meet certain medical and financial criteria. The Risperdal Patient Assistance Program and the Risperdal Reimbursement Support Program Eligibility is determined by financial criteria. The program also provides support obtaining insurance reimbursement.
Knoll Pharmaceutical
Company

Products: Mavik, Rythmol, Synthroid, Tarka Physicians should call the toll-free number above and request an evaluation form. Decisions are made on a case-by-case basis.
Lederle
Laboratiories

Eli Lilly and
Company

Products: Almost all prescription products; no controlled substances Patient eligibility is determined on a case-by-case basis in consultation with the prescribing physician. Applications are given to physicians. Pharmaceutical Assistance Programs Patients must meet financial criteria and have exhausted all other sources of assistance.
The Liposome
Company

Financial Assistance Program for Abelcet The physician should call to enroll the patient. The patient must meet financial eligibility criteria and have no other source of reimbursement.
Merck and Co., Inc. Patient Assistance Program
The physician should call the toll-free number above for an enrollment form. The application must be completed by the physician and patient. Eligibility is determined on a case-by-case basis. Patient Assistance Program for Aggrastat Patients must meet financial eligibility criteria and have no other source of reimbursement. The program can also assist in gaining reimbursement from insurance. The physician or patient may call for information. The program can assist patients in finding a payment source and may provide medication for those who meet financial criteria. The physician or patient may call for more information.
Novartis
Pharmaceuticals

Product: Certain single-source or life-sustaining products; no controlled substances The physician and patient must complete an application. Eligibility is determined on a case-by-case basis. Organon, Inc.
The physician should direct a request for assistance to a local sales representative. Eligibility is determined on a case-by-case basis. The physician should direct a request to a local sales representative.
Ortho Biotech Inc. Procritline
Products: Procrit (for non-dialysis use), Leustatin Injection Call the toll-free number above; this call can help determine if a patient meets medical and financial criteria.
Ortho
Dermatological

Patients can have no insurance coverage for medications and must have incomes below the federal poverty guidelines. The physician should request an application form.
Ortho-McNeil
Pharmaceutical, Inc.
Patient Assistance program
The physician should request an application. The patient can have no other source of reimbursement and must have income below the federal poverty guidelines.
Otsuka America
Pharmaceutical, Inc.
RxMAP Prescription Medication Assistance Program
Eligibility is based on the federal poverty guidelines and lack of other coverage. The physician should call for more information.
Parke-Davis
Pharmaceutical Assistance Programs Pfizer Inc.
While special application forms are not required, the physician must write a letter on the patient’s behalf. Products: Accupril, Accuretic, Dilantin, Estrostep, FemHRT, Lipitor, Loestrin, Neurontin, Zarontin The physician should request an application from a local sales representative. The patient must have no other source of reimbursement. Products: Certain single-source products The program operates through community, migrant, and homeless health centers. Only patients at these clinics are eligible. Diflucan and Zithromax Patient Assistance Program The physician should call for enrollment information. The patient must meet income eligibility criteria and may not have insurance or other assistance.
Pharmacia
Corporation

The patient or physician may initiate a request for assistance by calling the toll-free number above. An application form must be completed by the physician and patient. Products: Aldactazide, Aldactone, Calan SR, Kerlone, Calan, Covera-HS, Norpace, Norpace CR, Arthrotec, Celebrex, Cytotec The physician determines patient eligibility based on medical and financial guidelines. The physician should contact a local Searle representative or call on the patient’s behalf. Proctor & Gamble
Pharmaceuticals,
Inc.

Products: Actonel, Asacol, Dantrium capsules, Didronel, Macrodantin, Macrobid The physician and patient must complete an application form. Eligibility is determined on a case-by-case basis.
Rhone-Poulenc
Rorer, Inc.


Roche Laboratories Medical Needs Program
The physician must request an application form. The patient may not have insurance coverage or other assistance. Medical Needs Program for CellCept, Cytovene, and Cytovene-IV Products: CellCept, Cytovene, Cytovene-IV The physician should call for information. Medical Needs Program for Fortovase, Invirase, Cytovene, Cytovene-IV, and Hivid Products: Fortovase, Invirase, Cytovene, Cytovene-IV, Hivid For HIV patients. The physician should call for more information. Medical Needs Program for Kytril, Roferon-A, Vesanoid, Xeloda, and Fluorouracil Injection Products: Kytril, Roferon-A, Vesanoid, Xeloda, Fluorouracil Injection The physician should call for information.
Roxane Laboratories,
Inc.

Products: Oramorph SR, Roxanol, Roxanol 100, Roxicodone Physicians must call the program to discuss their patients’ eligibility. If the patient appears to meet insurance and financial eligibility, an application form will be mailed to the physician. Pharmaceutical Assistance Programs Sandoz
Pharmaceutical
Corporation


Sankyo Pharma
The physician must apply on a patient’s behalf. Patients must have no source of reimbursement. The program can help obtain insurance reimbursement for insured patients.
Sanofi-Synthelabo,
Inc.

Products: Several products, including Aralen, Danocrine, Primaquine The physician should call the toll-free number or the local Sanofi Winthrop representative. Eligibility is determined on a case-by-case basis.
Schering
Laboratories/
Key Pharmaceuticals
Commitment to Care
Patient eligibility is determined on a case-by-case basis. An application form must be completed by the physician and patient.
Serono, Inc.
A referral must be made by the physician. The physician should call for more information. Sigma-Tau
Pharmaceuticals,
Inc.

NORD/Sigma-Tau Carnitor Drug Assistance Program The patient must demonstrate financial need beyond any available reimbursement. The patient may call and submit an application. NORD/Sigma-Tau Matulane Patient Assistance Program The patient must show financial need and the physician must feel a treatment response is possible. The patient may call for information. SmithKline Beecham
Pharmaceuticals


Solvay Pharmaceuticals/
Unimed
Pharmaceuticals

Products: Aceon, Creon Minimicrospheres, Estratab, Estratest, Estratest HS, Lithobid, Rowasa, Anadrol, Marinol, Teveten The patient must meet financial eligibility criteria. The physician must call for an application form.
3M Pharmaceuticals Indigent Patient Pharmaceutical Program
Patients are considered on a case-by-case basis, based on financial need and insurance status. The physician should call for more information.
Takeda
Pharmaceuticals
America

The patient must meet financial eligibility criteria and have no other source of reimbursement. An application is sent to the physician. Unimed
Pharmaceuticals

Pharmaceutical Assistance Programs Wyeth-Ayerst
Laboratories

Product: Norplant five-year contraceptive system Eligibility is determined on a case-by-case basis. The physician should call for more information. Rheumatoid Arthritis Assistance Foundation The patient or physician should call to determine eligibility. The physician must identify a patient as indigent, defined as having low or no income and not covered by any third party. A limited supply of the requested medication is provided to the physician for dispensing to the patient.
Zeneca
Pharmaceuticals

Source: http://www.nciom.org/wp-content/uploads/2003/01/C23.pdf

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