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Patient Rx Solutions Program - Fareston
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Fareston Patient Assistance Program PO Box 325
Florham Park, NJ 07932
Phone
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866-325-8231
Fax:
866-694-2546
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Eligibility
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his program provides brand name medications at no or low cost to commercial and Medicare Part D insurance recipients that have no insurance coverage for the needed medication. Patients must be at or below 300% of the federal poverty level and must be a citizen or US resident. |
| Who Can Apply
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The doctor or doctor's office must call. |
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Required
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The doctor or doctor's office must call. for a prescreening and an application will be sent to the doctor's office. The doctor must complete a section of the application, sign and attach a prescription. The patient must complete a section of the application, sign and attach proof of income. The application must then be faxed or mailed. |
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Supply
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Up to 12 months |
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Ship To
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Doctor's office |
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Note
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This Company also offers a Reimbursement Program.
FARESTON Copay Assistance Card Program: Savings of up to $150 per month toward each prescription (after paying the first $20) for up to 12 prescriptions per year for eligible patients.
Contact program for Spanish 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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| Fareston Tablets |
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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 |
| Download printable Form |
(Requires Acrobat Reader) 
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Patient Rx Solutions Program - Sancuso
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Patient Rx Solutions Sancuso
Patient Assistance Proram PO Box 325
Florham Park, NJ 07932
Phone
:
866-325-8231
Fax:
866-694-2546
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage for the needed medication. Patients with Medicare Part D are not eligible. Patients must be at or below 300% of the federal poverty level and must be a US citizen or legal resident. |
| Who Can Apply
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Patients and healthcare providers can call to have an application faxed, mailed or it can be downloaded. |
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Required
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Doctors must complete a section of the application, sign and attach a prescription. Patients must complete a section of the application, sign and attach proof of income. The application can then be faxed or mailed. |
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Supply
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Varies |
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Ship To
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Doctor's office |
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Note
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This Company also offers a Reimbursement Program.
SANCUSO Copay Assistance Card Program: Save up to $150 on each prescription after paying the first $20. Each SANCUSO card is good for 24 fills, up to 4 patches per fill up to a maximum of 48 patches, subject to your prescription coverage.
Contact program for Spanish application. |
| |
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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| Sancuso transdermal patch |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| (Requires Acrobat Reader)
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