|
Novo Nordisk Hormone Therapy Patient Assistance Program
|
PO Box 181640
Louisville, KY 40261
Phone
:
(866)310-7549
Ext
Fax:
(866)441-4190
|
Eligibility
|
> |
The patient must have no prescription coverage for any medications and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident or legal alien. |
Who Can Apply
|
> |
With the patient's permission, anyone concerned can call for an application. |
Required
|
> |
The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section and sign the application. Proof of income is also required. |
Supply
|
> |
A 90-day supply of medication wil be provided. |
Ship To
|
> |
The shipement will be sent to the healthcare providers office. |
Note
|
> |
|
|
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. |
Vagifem 18 tablet; vaginal |
Vagifem tablet; vaginal |
|
|
|