|
Novartis Patient Assistance Foundation, Inc.
|
PO Box 52029
Phoenix, AZ 85072
Phone
:
800-277-2254
Fax:
855-817-2711
|
Eligibility
|
> |
This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must be a US resident. |
Who Can Apply
|
> |
Patients or healthcare providers can call to have an application faxed or download one. |
Required
|
> |
Doctors must complete a portion of the application, sign and attach a prescription for 90 days. Patients must complete a portion of the application, sign and attach a copy of proof of income. |
Supply
|
> |
Varies |
Ship To
|
> |
Doctor's office or patient is sent card to be used at pharmacy. |
Note
|
> |
For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician. |
|
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. |
Arcapta Neohaler powder; inhalation |
Coartem tablet |
Entresto tablet |
Focalin XR capsule; extended release |
Glatopa injection |
Lamisil granule; oral |
Myfortic tablet; delayed release |
Neoral |
Omnitrope injection |
Reclast injectable; iv (infusion) |
Sandimmune |
Tegretol |
Tegretol XR tablet; extended release |
Tekturna HCT tablet |
Tekturna tablet |
Tobi Podhaler powder; inhalation |
Tobi solution; inhalation |
Trileptal tablet |
Tyzeka tablet |
Zortress tablet |
|
Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
Download printable Form |
(Requires Acrobat Reader)
|
|
|