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Bayer Patient Assistance Program for Nimotop & Precose
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PO Box 29209
Phoenix, AZ 85038-9209
Phone
:
800-998-9180
Ext OPT 1
Fax:
Not Applicable
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Eligibility
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The patient must meet insurance and financial guidelines that are not disclosed. The patient must be a US citizen or legal US resident. |
| Who Can Apply
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The patient or doctor needs to call for a prescreening. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application. |
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Supply
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The patient is sent a pharmacy card. |
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Ship To
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Patient's home |
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Note
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The patient or doctor needs to call for a prescreening. |
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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.
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| Precose (acarbose) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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REACH (Resources for Expert Assistance and Care Helpline)
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PO Box 221289
Charlotte, NC 28222-1289
Phone
:
877-322-4448
Fax:
866-639-5181
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Eligibility
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The patient may be uninsured or be insured but experiencing difficulty accessing the medications. the patient must also also have limited financial resources. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must complete the appropriate section and sign the application.The patient must also complete, sign the application and attach proof of income. |
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Supply
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Ship To
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Doctor's office |
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Note
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With the patient's permission, anyone concerned can call for an application. |
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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.
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| Campath |
| Fludara (fludarabine phosphate) |
| Leukine (sargramostim) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| (Requires Acrobat Reader)
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Betaseron Patient Assistance Program
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PO Box 221349
Charlotte, NC 28222-1349
Phone
:
877-836-5724
Fax:
877-744-5615
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Eligibility
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The patient must meet insurance and financial guidelines that are not disclosed. The patient must also have MS.The patient must also be a US resident. |
| Who Can Apply
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The doctor or patient can call to request an application. |
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Required
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The doctor needs to complete an application, sign it and attach a prescription.The patient needs to complete an application, sign it, and attach proof of income and other requested documentation. |
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Supply
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A 90-day supply |
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Ship To
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Patient's home |
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Note
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The doctor or patient can call to request an application. |
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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.
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| Betaseron (interferon beta-1b) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| (Requires Acrobat Reader)
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Bayer Patient Assistance Program
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6 West Belt
W66
Wayne, NJ 07470-6806
Phone
:
888-842-2937
Ext OPT 7 or 3
Fax:
973-305-3545
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Eligibility
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The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. The patient must be a US citizen or legal US resident. |
| Who Can Apply
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The patient or doctor should call for an application. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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The patient or doctor should call for an application. |
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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.
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| Adalat CC (Nifedipine) |
| Angeliq Tablets |
| Avelox Tablets |
| Betapace AF Tablets |
| Biltricide (praziquantel) |
| Cipro HC Ophthalmic Solution |
| Cipro I.V. (ciprofloxacin) |
| Climara Pro transdermal |
| Climara transdermal |
| DTIC-Dome (decarbazine) |
| Precose (acarbose) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| Download printable Form Angeliq Form |
| Download printable Form Climara Form |
| Download printable Form Climara Pro Form |
| (Requires Acrobat Reader)
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Nexavar Reach Program
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PO Box 220765
, NC 28222-0765
Phone
:
877-322-4448
Fax:
866-639-5181
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income and other eligibility guidelines that are not disclosed. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Ship To
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Patient's home |
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Note
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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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.
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| Nexavar |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| Download printable Form Spanish Version |
| (Requires Acrobat Reader)
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