--=====================_857145541==_ Content-Type: text/plain; charset="us-ascii" --=====================_857145541==_ Content-Type: text/plain; charset="us-ascii" Subject: Help for those with PD who can't afford the Meds I thought that I had previously posted this, couldn't find it in the archive, so here it is. Indigent Drugs Prepared by the Staff of the Special Committee on Aging, United States Senate, Senator David Pryor, Chairman August 1994 This list was updated as of October 1994 by E. Loren Buhle, Jr. Ph.D I recommend you use your SEARCHING tool in your word processor to find either the drug or the pharmaceutical company. 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 assistanc 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 Information 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: Gross monthly income must be less than 200% of Federal poverty guidelines. All applications will be reviewed within establish criteria and on a case-by-case basis. Patients must be residents of the United States or territories. All alternative funding sources must be investigated. All required information must be provided for consideration of eligibility. 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: Prokine (Sargramostim) Lasix Trental 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 250 mcg Leukine 500 mcg Hydraea Rubex 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 MyambutolPhysician 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 902-218-6894Products 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 needindicate the existence of financial hardshipindicate 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: 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. 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. 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 othe 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 Company7000 Portage RdKalamazoo, 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: TriphasilLo/OvralNordette 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 This list was updated as of October 1994 by E. Loren Buhle, Jr. Ph.D John Cottingham NEW ADDRESS: [log in to unmask] ================================================================= --=====================_857145541==_ Content-Type: text/plain; charset="us-ascii" [log in to unmask] That man may last, but never lives, Who much receives, but nothing gives; HomeBoy #Parkinsons Whom none can love, whom none can thank,-- Creation's blot, creation's blank. John Cottingham Thomas Gibbons (1720-1785): When Jesus dwelt. --=====================_857145541==_--