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Pharmaceutical Reimbursement Assistance Programs

Authors: Staff of the Special Committee on Aging
October, 1994
Prepared by the Staff of the Special Committee on Aging, United States Senate, Senator David Pryor, Chairman

The following drug companies have programs that will allow your patients to receive free prescription drugs.

Each drug company offers about the same program. Some are a little different. What it amounts to is either you, or the patient call the representative I have listed and request information on how to get signed up for their Indigent Patient Program. The drug company will then send either you or the patient the forms to fill out.

There are maybe 10 questions on each form. It is very simple. You send the form back with a prescription for the drugs, in the name of the patient, and they mail you back a three month supply. Just pick up the phone and call the patient to come pick them up at your office.


Adria Laboratories

Contact: Adria Laboratories Patient Assistance program
P.O.Box 9525
McLean VA 22102
Phone: 1-800366-5570

  • Drugs Available:
  • Adriamycin PFS
  • Adrucil
  • Folex
  • Idamycin
  • Neosar
  • Tarabine
  • Vincasar

Two months supply. Physician must certify patient is unable to afford the cost of the drug, and is unable to obtain assistance elsewhere.


Allergan Prescription Pharmaceuticals

Contact: Judy McGee 1-800-347-4500 ext. 4280

  • Drugs Available:
  • Betagan
  • Bleph-10
  • Blephamide
  • FML
  • HMS
  • Oculinium
  • Pilogan
  • Propine
  • other OTC tear products

Course of therapy, up to a maximum of 6 months supply. Eligibility criteria are at the physician's descretion.


Amgen, Inc.

Contact: Amgen Safety Net Programs
Medical Technology Hotlines: 1-800-272-9376 (202-637-6698 in Washington, D.C.)

  • Drugs Available:
  • Epogen
  • Neupogen

Amgen's program consists of a universal patient program and a variable cap prograam for uninsured patients. Enrollment in the program is based on a patient's insurance and financial status.


Astra

Contact: F.A.I.R. (FOSCAVIR Assistance and Infomration on Reimbursemebt) 1-800-488-3247

* Foscavir (Foscarnet Sodium)

The physician must sign and complete the application and return it within seven days to the address indicated on the form. The qualification form must also be accompanied by a signed prescription.


Boehringer Ingleheim Parmaceuticals, Inc.

Contact: PARTNERS IN HEALTH 1-800-556-8317

  • Products Available:
  • Persantine
  • Atrovent
  • Alupent
  • Catapres

Controlled substances are not covered. Maximum of three months. Patient cannot have prescription coverage, cannot be eligible for Medicaid/State assistance programs, and must meet annual income guidelines. Physician must initiate request.


Bristol Myers Squibb #1

(General Indigent Patient Program)
Contact: Bristol-Myers Indigent Patient Program
P.O. Box 9445
McLean, VA 22102-9998
1-800-736-0003
1-703-760-0049 (FAX)

  • Products Available:
  • Duricef
  • Cefzil
  • BuSpar
  • Desyrel
  • Estrace
  • Ovcon-35
  • Ovcon-50
  • Natalins
  • Natalins RX
  • Vagistat-1
  • Mycostatin

Three months' supply. Physician's request.


Bristol Myers Squibb #2

(Cardiovascular Access Program)
Contact: Bristol-Myers Cardiovascular Access Program
P.O. Box 9445
McLean, VA 22102-9998
1-800-736-0003
1-703-760-0049 (FAX)

  • Products Available:
  • Capoten
  • Capozide
  • Corgard
  • Corzide
  • Klotrix
  • K-Lyte
  • Monopril
  • Naturetin
  • Pravochol
  • Pronestyl-SR
  • Questran Light
  • Ranzide
  • Saluron
  • Salutensin
  • Vasodilan
  • Betapen-VK

Three months' supply. The patient must work through an enrolled physician, cannot be eligible for any other sources of drug coverage, such as Medicaid, or private insurance, and must be deemed financially eligbile, as determined by "means" and "liquid assets" tests.


Bristol Myers Squibb #3

Cancer Patient Access Program
Contact: Bristol-Myers Squibb
2400 West Lloynd Expressway
Evansville, IN 47721
Mail Code R-22
1-800-437-0994

  • Products Available:
  • BICNU
  • CEENU
  • Lysodren
  • Mutamycin
  • Mycostatin Pastilles
  • Paraplatin
  • Planitol
  • Planitol-AQ
  • VePesid
  • Blenoxance
  • Cytoxan
  • Lyophilized Cytoxan
  • Ifex
  • Mesnex
  • Megace

Two months' supply. Internal financial screening on a case-by-case basis.


Burroughs-Wellcome

Contact Patient Information Services
Burroughs-Wellcome Co.
P.O. Box 52035
Phoenix AZ85072-9349
1-800-722-9294 (Program Enrollment)

  • Products Available:
  • Septra
  • Septra DS
  • Lanoxin
  • Mepron
  • AZT (Retrovir)
  • Zovirax
  • Zyloprim
  • Imuran
  • Wellcovorin

The products are available in a 30-day supply, with a maximum of 90 days therapy. Eligibility criteria that have to be met:

1. Gross monthly income must be less than 200% of Federal poverty guidelines.
2. All applications will be reviewed within establish criteria and on a case-by-case basis.
3. Patients must be residents of the United States or territories.
4. All alternative funding sources must be investigated.
5. All required information must be provided for consideration of eligibility.
6. Patients may be approved (occasionally) by exception if extreme extenuating circumstances exist.


Ciba-Geigy Pharmaceuticals Contact: Jackie LaGuardia, Senior Information Assistant
Ciba-Geigy Corporation
556 Morris Ave, D2058
Summit, NJ 07091
1-800-257-3273

All the company's products (including those distributed by Basal and Summit) are covered under the program, which include:
* Lopressor
* Lotensin
* Lioresal
* Slow K
* Tegretol
* Voltaren
* Brethine
* Estraderm
* Transderm Nitro

Ritalin and Rimactane are controlled substances and are not covered. Up to a 3 months supply available.


Du Pont Merck

Contact: Darlene Samis
Du Pont Pharma
P.O. Box 80026
Wilmington, DE 19880-0026
1-800-474-2762
1-302-234-4327

  • Drugs Covered:
  • Coumadin
  • Lodosyn
  • Sinemet
  • Sinemet CR
  • Symmetrel
  • Trexan
  • Vaseretic

Controlled substances are not covered, which include Percodan and Percocet. Thirty days' supply. The patient must be indigent and ineligible for a Federal or State Government pharmaceutical assistance program.


Genentech, Inc

Contact: Genentech Reimbursement Hotline
P.O. Box 2586
S. San Francisco, CA 94083-2586
1-800-530-3083

  • Products Available:
  • Protropin (Human Growth Hormone)
  • Activase (TPA, Tissue Plasminogen Activator)
  • Actimmune (Interferon Gamma-1b)
  • Nutropin
  • Pulmozyme

Quantity provided and eligibility requirements are variable. Patients are asked to provide sufficiently detailed information to assure the company that they are uninsured and cannot afford the required payments. (For Activase: If an uninsured patient has a gross family income of $25,000 or less, the company provides replacement product to the hospital.)


Glaxo, Inc.

Contact: Laura N. Wright, Supervisor
Glaxco Indigent Patient Program
Glaxco, Inc.
P.O. Box 13438
Research Triangle Park
NC27709
1-800-452-9677
1-919-248-7971 (FAX)

  • Products Available:
  • Zantac
  • Ceftin
  • Ventolin
  • Beconase
  • Beconase AQ
  • Trandate

Maximum three months' supply. Patient must be a private outpatient whom the physician considers medically indigent and who is not eligible for any other third-party reimbursement.


Hoechst-Roussel, Pharmaceuticals, Inc.

Contact: Joyce Trotter, Field Forest Development
1-800-422-4779 Products Available:
o Prokine (Sargramostim)
o Lasix
o Trental
o Diabeta

Must show lack of insurance or ability to pay. The company indicated that it provides other products to indigents upon receipt of a prescription and a physician's letter certifying that the patient is indigent. Eligibility is on a case-by-case basis. This policy covers patients who are ineligible for a third-party payer or Medicaid coverage. One course of therapy (usually two to three weeks).


Hoffman-LaRouche, Inc.

Contact: Inge Shanahan
Medical Communications Associate
Roche Laboratories
340 Kingsland Street
Nutley, NJ 07110
1-800-526-6367
Teleprompter #2
201-235-2765 (FAX) They do not accept FAXed applications.

  • Products Available: All products are covered including
  • Valium
  • Librium
  • Limbritol
  • Dalmane
  • Hivid
  • Bactrim
  • Bactrim DS
  • Klonopin
  • Efudex (Fluorouracil Injectible)
  • Gantrisin
  • Gantanol
  • Interferon 2-A Recombinate
  • Rocephin Injectible
  • Rocaltrol

Three months' supply. Eligibility limited to private practice outpatients who are considered by the physician to be medically indigent and who are not eligible to receive Roche drugs through any other third-party reimbursement program. The physician's signature and DEA number are required for all applications, whether or not the request is for a controlled prescription drug. Drugs are shipped to registered DEA addresses only.


Immunex Corporation

Contact: Professional Services Immunex Corporation
1-800-Immunex or 1-800-466-8639
206-587-0430
1-800-221-6820 (FAX)

Products Available:
* Leukine (Sargramostim) 250 mcg
* Leukine (Sargramostim)500 mcg
* NOVANTRONE (mitoxantrone concentrate for injection)
* THIOPLEX (thiotepa)
* Methotrexate sodium (injectable forms only)
* Leucovorin calcium
* Etoposide injection
* AMICAR (aminocaproic acid)
* LEVOPROME (methotrimeprazine)

Three cycles. Physician must attest that the patient requires the drug and that all the reimbursement options for the patient have been tried.


Janssen Parmaceutica #1

Contact: Professional Services Department
Janssen Pharmaceutica Inc.
1125 Trenton-Harbourton Road
P.O. Box 200 Office A32000
Titusville, New Jersey 08560-0200
1-800-526-7736

Products Available:
* Ergamisol (Levamisole HCL)
* Hismanal
* Alfenta
* Sufenta
* Sublimaze
* Risperdal (1-800-652-6227)

Varies by product, patient condition. Physician determines that patient is indigent and not eligible for health insurance. Physicians may request free medications by written or telephone requests, accompanied by a signed and dated prescription and letter stating financial status and need of the patient.


Janssen Parmaceutica #2

Contact: Janssen Patient Assistance Program
1800 Robert Fulton Drive
Reston, VA 22091
1-800-544-2987

Products Available:
* Ergamisol (Levamisole HCL)
* Nizoral
* Sporanox
* Duragesic

One or two months supply, varies by product. Patient must have less than $25,000 total annual household income and can have Medicare or private insurance, but cannot have prescription coverage.


Knoll Pharmaceuticals

Contact: Knoll Pharmaceuticals
Indigent Patient Program
30 N. Jefferson RD.
Whippany, N.J. 07981
1-800-524-2474

Drugs Available:
* Isoptin
* Rythmol
* Santyl
* Zostrix

Patients can enroll in the Heart-in Harmony program to receive educational information. Contact the local company sales representative, or call the patient help line.


Lederle Laboratories

Contact: Jerry Johnson, Pharm. D., Director
Induxtry Affairs
American Cyanamid, Inc
. One Cyanamid Plaza
Wayne, New Jersey 07470
1-800-533-2273
1-201-831-4484 (FAX)

  • Drugs Available:
  • Diamox
  • Artane
  • Mincoin
  • Leucovorin
  • Calcium Loxapine
  • Verelan
  • Rheumatrex
  • Maxzide
  • Myambutol

Physician has tomake the request. Patients have to be financially indigent, and not eligible for coverage under third party insurance or Medicaid reimbursement.


Eli Lilly, Inc.

Contact: Indigent Patient Program Administrator
Eli Lilly and Company
Patient Assistance Program
P.O. Box 9105
McLean, VA 22102-0105
1-800-545-6962

  • Products Available:
  • Ceclor
  • Keflex
  • Prozac
  • Dymelor
  • Axid
  • along with all insulin products such as Humulin and Iletin

This program does not cover controlled substances, which include Darvon and Darvocet products. Quantities are dependent on the product and the physician's instructions. Patient eligibility is determined on a case-by-case basis in consultation with the prescribing physician. Patients are not required to complete enrollment forms. Physicians are asked to submit a written request containing specific information.


Marion-Merrell Dow, Inc.

Contact: Indigent Patient Program
P.O. Box 8480
Kansas City, MO 64114
1-800-362-7466

  • Products Available:
  • Cardizem
  • Cardizem SR
  • Cardizem CD
  • Carafate
  • Pavabid
  • Seldane
  • Seldane-d
  • Nicorette
  • Rifidin
  • Quinamm
  • Lorelco

Three months' supply. The physician determines whether the patient is eligible for the program.


McNeil Pharmaceutical

Contact: Thomas Schwend, Manager
Medical Information
McNeil Pharmaceutical Corporation
P.O. Box 300
Route 202 South
Raritan, NJ 08869-0602
902-218-6894

  • Products Available:
  • Pancrease
  • Parafon Forte DSC
  • Haldol
  • Vascor
  • Tolectin

Varies by product, patient condition. Physician determines the patient is indigent and not eligible for health insurance. Physicians may request free medications by written or telephone request, accompanied by a signed and dated prescription and letter stating financial status and need of patient.


Merck, Sharp, and Dohme

Contact: Complimentary Products Program
Merck and Co., Inc.
P.O. Box 106634
Atlanta, GA 30348
1-800-637-2579

  • Products Available:
  • Mevacor
  • Plendil
  • Pepcid
  • Prilosec
  • Prinivil
  • Proscar
  • Timoptic
  • Timolol
  • Clinoril
  • Flexeril
  • Periactin
  • Noroxin
  • Cogentin
  • Indocin
  • Aldomet
  • Dolobid
  • Vasoretic
  • Vasotec

No injectibles. Requests for three months' supply are generally honored. The patient's physician must:
* provide awritten statement of medical need
* indicate the existence of financial hardship
* indicate the lack of patient eligibility for prescription coverage from
insurance or government assistance programs

Physician must also send a signed and dated written prescription with doctor's DEA number.


- Miles Pharmaceuticals

Contact: Professional Services
Attention: Miles Indigent Patient Program
400 Morgan Ave
West Haven, Connecticut 06516
1-203-937-2373

Products Available:
* Cipro
* Nimotop
* Tridesilon Cream

Medication quantities and duration of support is determined on a case-by-case basis. Physician must certify that the patient is not eligible for or covered by government funded reimbursement or insurance programs for medication. Patient's income must be below federal poverty lines.


Ortho Biotechnology

Contact: Jacob Drapkin, Director
Health Care Systems
Ortho Biotech Financial Assistance Program
1800 Robert Fulton Drive
Reston, VA 22091
908-704-5074
908-526-4997 (FAX)

Assistance Program is for:
* PROCRIT (Epoetin alfa)
* LEUSTATIN (cladribine) Injectible

Program Criteria:
1. Financial Assistance Program (FAP) 1-800-447-3437 provides PROCRIT therapy free of charge to any qualifying nondialysis patient who cannot obtain insurance coverage, is uninsureed or cannot afford the cost of their treatment.
2. Cost Sharing Program 1-800-441-1366 limits the annual cost of PROCRIT expenditures for a patient exceed approximately $8,500 for a calendar year, regardless of third party coverage.
3. LEUSTATIN Financial Assistance Program 1-800-447-3437 provides LEUSTATIN therapy free of charge toall persons who meet specific criteria and lack financial resources and third-party insurance necessary to obtain treatment.


Parke-Davis

Contact: Indigent Patient Program 201-540-2000

Products Available: All products except Centrax, those available include:
* Dilantin
* Mandelamine
* Accupril
* Pyridium
* Nitrostat Sublingual
* Tabrom
* Ponstel
* Procan
* Anusol HC
* Zarontin

All applications are taken over the phone. To apply, patient or doctor calls Parke Davis with the following information:

Doctor's full name:
address:
phone number:

Patient's name:
address:
phone number:
financial status:


Pfizer Pharmaceuticals, Inc #1

Contact: Mark Clark
Pfizer Indigent Patient Program
P.O. Box 25457
Alexandria, VA 22314
1-800-646-4455

  • Products Available:
  • Antivert
  • Marax
  • Diabinese
  • Cardura
  • Minizide
  • Navane
  • Sinequan
  • Zithromax
  • Feldene
  • Procardia
  • Procardia XL
  • Vibramycin
  • Vistril
  • Zoloft
  • Minipress
  • Minizide
  • Glucotrol

Up to three months' supply at one time, as prescribed by the physician. Any patient that a physician is treating as indigent is eligible. Patient must not be covered by third-party insurance or Medicaid. Usually three to four weeks to receive medication. Refills are available upon request by doctor.


Pfzier Inc, Program #2: Roerig Division

Contact: Diflucan Patient Assistance Program
1-800-869-9979

Product Covered:
* Diflucan

Up to three months' supply at one time and then can reapply. Patient must not have insurance or other third-party coverage. Patient must not be eligible for a state AIDS drug assistance program. Patient must have anincome of less than $25,000 a year without dependents; or less than $40,000 a year with dependents.


Proctor & Gamble Pharmaceuticals, Inc

Contact: Customer Service
17 Eaton Avenue
Norwish, NY 13815
1-800-448-4878
1-607-335-2998 (FAX)

Products Available:
* Asacol
* Dantrium
* Macrodantin

The quantity varies depending upon the situatin, but at least a one month supply can be obtained upon receit of a physician's prescription. The company relies on the physician's appraisal of the patient need. The company also helps the patient identify other sources of financial help to pay for the patient's medications.


R&D Laboratories

R&D Laboratories, Inc.
4094 Glencoe Avenue
Marina del Ray, California 90292
1-800-338-9066

Every R&D Laboratories pharmaceutical nutritional supplement has a special Indigent Patient Program sticker. Patients bring the sticks from their bottles of R&D products with them when they come to the dialysis unit. Stickers are attached to the back of a booklet supplied by the company and the completed booklet is returned to R&D Laboratories. For every 12 stickers we receive from a unit, R&D sends nutritional product of facility's choice for free distribution to indigent patients.


Sandoz Parmaceuticals, Inc.

Contact: Maria Hardin, Director
Sandoz Drug Cost Sharing Program
P.O. Box 8923
New Fairfield, CT 06812-1783
1-800-447-6673 (for all drugs)
1-800-937-6673 (for Clozaril)

The National Organization for Rare Disorders (NORD)/Sandoz Drug Cost Share Program (DCSP) is solely administered by NORD.

Products available:
* Sandimmune
* Sandoglobulin
* Sandostatin
* Parlodel
* Eldepryl * Clozaril (under a separate program)

Patient is awarded up to one year's supply of drug, which is shipped in three month supplies via the mail-order pharmacy utilized by the program. Clozaril-Patient is eligible to receive up to one year's supply of the drug, dispensed only one week at a time, per dispensing requirements of package label. NORD determines eligibility by medical and financial criteria, and applies a cost share formula. The patient/applicant must demonstrate financial need above and beyond the availability of Federal and State funds, private insurance, or family resources. NORD also determines patient eligibility for Clozaril program.


Sanofi Winthrop Pharm, Inc.

Contact: Sanofi Winthrop
Product Information Department
90 Park Avenue
New York, NY 10016
1-212-907-2000
1-800-446-6267 (Push #1 twice when automated answering machine picks up)

Products Available:
* Aralen
* Danocrine
* Winstrol

One unit or one month supply, as requireed. Subject to acceptance by the company, patients can obtain medications by having their physician contact the company to request the product, provide a written order for the product, and confirm the patient's need.


Schering-Plough

Contact: For Intro/Eulexin Products:
Roger D. Graham Jr.
Marketing Manager
Oncology/Biotech
Service Program
Schering Laboratories
2000 Galloping Hill Road
Building K-5-2B2
Kenilworth, NJ 07033

For other Schering products:
Drug Information Services Indigent Propgram
908-298-4000
1-800-526-4099

Products Available:
* Inton-A - a supply for three months; renewals available for three months at a time
* Eulexin - Initial supply is for six months; renewals available for six months at a time
* Trinalin
* Lotrimin
* Lotrisone
* Diprosone
* Diprolene
* Fulvicin
* Proventil
* Vancenase
* Normodyne
* Optimine

Where not specified, these drugs are provided for up to three month; renewals available for three months at at time. Patient eligibility is determined on a case-by-case basis, on inernal criteria. The consutlation includes a review of the specific case, as well as the availability of other means of health care assistance.


G.D. Searle and Co.

Contact: "Patients in Need" Foundation
Searle Co.
P.O. Box 5110
Chicago, IL 60680
1-800-542-2526
1-708-470-6280 (FAX)

For general information abou the program:
Laura Leber, Associate Director
Public Affairs
1-708-470-6280

Products Available
* Aldactazide
* Aldactone
* Calan
* Calan Sr
* Cytotec
* Kerlone
* Nitrodisc
* Norpace
* Norpace CR

Supply is based on the physician's assessment of the needs for the patient. The program is conducted through the physician, who determines the patient's eligibility based on medical and economic need. Searle provides suggested guidelines to the physician for determination of patient eligibility.


Sigma-Tau Parmaceuticals, Inc.

Contact: Michelle McCourt
Carnitor Drug Assistance Program, Administrator
National Organization for Rare Disease Disorders
P.O. Box 8923
New Fairfield, CT 06812-1783
1-800-999-6673 or 203-746-6518
1-203-746-6481 (FAX)

Product available:
* Carnitor (Levocarnitine)

Three months' supply, up to one year. The patient must have no other means for obtaining the drug through insurance or State or Federal Assistance, or liquid assets, and cannot afford to purchase the drug. Must be a U.S. citizen or permanent resident.


SmithKline Beecham: Program #1

Contact: SB Access to Care Program
SmithKline Beecham Pharmaceuticals
One Franklin Plaza FP-1320
Philadelphia, PA 19101
1-800-546-0420 (patient requests)
1-215-751-5749 (physician requests)

Products Available:
* Tagamet
* Augmentin
* Relafen
* Dyazide
* Riduara
* Bactroban
* Compazine
* Amoxil
* Ridaura
* all other SmithKline Beecham prescription products

Individual physicians determine which patients are eligible and would benefit most from the Access to Care Program. Physicians are required to submit forms to enroll patients in the program. Three months' supply is available at one time. Requests must originate from the physician.


Smithkline Beecham: Program #2

Contact: Eminase/Triostat Compassionate Care Programs
SmithKline Beecham Pharmaceuticals
One Franklin Plaza FP-1320
Philadelphia, PA 19101
1-800-866-6273

Products Available:
* Eminase
* Triostat

Patients must demonstrate ineligibility for other forms of medical assistance and meet the program's income requirements (single patients with annual incomes of $18,000 or less will be eligible, andpersons who are married or have at least one dependent will be eligible if their annual incomes are $25,000 or less). For each eligible patient, hospitals should submit a Hospital Consent Form and an ApplicationForm with any one of the following documents: a copy of the patient's medical record, a pharmacy record, or the patient's bill.


Syntex Laboratories, Inc.

Contact: Cytovene Medical Information Line: 1-800-444-4200
General telephone number to inquire about indigent programs: 1-800-822-8255

Products Available:
* Cytovene (anciclovir sodium) 500mg sterile powder
* Naprosyn
* Anaprox
* Cardene
* Synalar
* Synemol
* Ticlid
* Toradol
* Lidex
* Nasalide

Up to 25 vials of Cytovene are available. Syntex provides Cytovene free of charge when it is prescribed for an immunocompromised patient who has been diagnosed as having cytomegalovirus (CMV) retinitis, if that patient lacks the means to purchase the drug, and that patient is ineligible for any form of third-party reimbursement to pay for that drug.


Upjohn Company

Contact: Patient Consumer Information
Upjohn Company
7000 Portage Rd
Kalamazoo, MI 49001
616-323-6004
616-323-4551 (FAX)

Products Available:
* Ansaid
* Motrin
* Provera
* E-Mycin
* Halcion
* Xanax
* Medrol
* Cleocin
* Lincocin
* Loniten
* Micronase
* Orinase
* Tolinase

Health Care Professionals should contact their local Upjohn Representative. Generally, a three months' supply is provided. However, a physician can request a supply for a longer period of time. The physician deterines the patient's needs, and if insurance or other social programs to help provide medications are available.


Wyeth-Ayerst Laboratories #1

Contact: Wyeth-Ayerst Laboratories Indigent Patient Program
Roger J. Eurbin, Professional Services, IPP
P.O. Box 8299
Philadelphia, PA 19101
1-800-568-9938

All Product Covered:
* Sectral
* Cyclospasmol
* Premarin
* Isordil
* Phenegran
* Orudis
* Wytensin
* Cardarone
* Birth Control Pills for Family Planning Clinics:
Triphasil
Lo/Ovral
Nordette

In general, one or two months supply or the closes trade package size available is provided. For Cordarone, one month supply or up to two bottles of 60 tablets is provided. The number of cycles of oral contraceptives given to the patient is determined by a health care provider or the family planning clinic. The patient must be medically indigent, with no form of coverage for pharmaceutical products. The family planning clinic determines eligibility for new and refill oral contraceptive cycles.


Wyeth-Ayerst Laboratories #2

Contact: Norplan Foundation
P.O. Box 25223
Alexandria, VA 22314
703-706-5933

* Norplant (levonorgestrel implants)

Eligibility deteremined on a case-by-case basis and limited to individuals who cannot afford the product and who are ineligible for coverage under private and public sector programs.
-


Zeneca Pharmaceuticals

Contact: Yvonne A. Graham, Manager, Professional Services
Zeneca Pharmaceuticals Group
P.O. Box 15197
Wilmington, DE 19850-5197
1-800-424-3727
302-886-2231

Products Available:
* Nolvadex
* Zestoretic
* Bucladin-S
* Kinesed
* Sorbitrate
* Tenormin
* Tenoretic
* Zestril

One to three months supply with application.


These drugs are available usually just for the asking. Please give your patient the best care and take the time to fill out the form and mail it back to the drug company. It takes so little time to do so and it will benefit the patient greatly.

You may order copies of this list free of charge by picking up the phone and calling the Unisted States Senate, Department of Aging: Majority: 202-224-5364 Minority: 202- 224-1467

Source: OncoLink Home Page
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