medprog



Most pharmaceutical manufacturers have patient assistance programs to provide medication for people with low incomes, no insurance, or no drug coverage. Before we begin listing resources, there are two important facts you need to know:

Many well-informed medical professionals are unaware that these programs exist. In fact there are nearly 50 pharmaceutical companies (and more than 900 medications) involved in these programs.

It may be necessary to ask your doctor's office to research the availability of the medication to determine if there is a drug for you that is available free of charge. Generally, your physician must process your request and, if you qualify, distribute the medication. The drug manufacturer will not send the medication directly to you.

Each company has special requirements, forms, and procedures. Although there is no central clearinghouse for obtaining up-to-date information about these programs or the drugs themselves, various resources can help. Each manufacturer has its own criteria, but some parameters include:

Eligibility will be determined by your income level, overall circumstances, and insurance status. You must be ineligible for third-party reimbursement or support programs. You will be given a limited supply of medication and you will have to reapply for refills. Some programs mandate the physician waive his or her fee Medication must be used for FDA-approved applications. In most cases, you must be a legal US resident.

About opioids

The current controversy on the use of opioids to treat chronic pain has prompted many manufacturers to remove these drugs from their patient assistance list. One exception is Purdue Pharma, manufacturer of OxyContin®, MS Contin®, MS IR®, and OxyFast®. Your physician must call the Purdue Pharma Patient Assistance Program (800) 599-6070 and request an application for you. A Purdue Pharma sales representative will call on your physician and expedite the process.

Resources

The Pharmaceutical Research and Manufacturer's Association (PhRMA) The PhRMA, a trade group for the pharmaceutical industry, has compiled a Patient Assistance Directory of drug companies participating in this program, their eligibility criteria, and the application processes for its program PhRMA recently added an on-line application process to pre-qualify patients (go to http://www.phrma.org). You can access the directory via the website or you can call (800) 762-4636 for the printed directory. A recording will ask for your name and address. You will receive the directory by mail in a couple of weeks. In addition, the association sponsors www.HelpingPatients.org for patients in need of assistance.If you do not find the answer to your question here, you should contact the drug manufacturer directly. Telephone numbers are listed in the directory.

Medicare, Medicaid, and Medigap

The Prescription Drug Assistance Programs section of http://www.medicare.gov provides information on programs that offer discounts or free medication to individuals in need. To find information on prescription drug assistance programs, Medicare managed care plans, and Medigap plans that offer prescription drug coverage in your area, go to http://www.medicare.gov/Prescription/Home.; you can complete a form on the site and then select "View Results" to see if you qualify.

www.Rxhope.com

Rxhope is a free web-based service that helps prescribers and patient advocates apply, obtain, and track requests for no cost medication for patients who can't afford them and who have no access to prescription insurance or government-funded programs. They can help identify --Federal, state, and charitable agencies that have patient assistance programs --Ways to register on the Internet --How to navigate the Drug Information Center, State, and Federal Assistance Programs --Healthcare Links (provide access to healthcare information from the medical profession and pharmaceutical industry) Pharmaceutical Company Links

The Medicine Program

If you qualify for assistance, this organization works with your physician to help you enroll in one or more of the many patient assistance programs now available. The Medicine Program requires a $5 processing fee for each medication requested.

These programs provide prescription medicine free-of-charge to individuals in need, regardless of age, if they meet the sponsor's criteria. If you are approved and enrolled, your medication will be sent to your physician to dispense it to you. If the program's sponsor approves your application, you will receive your medication at no charge.

To be approved for enrollment, some of the primary requirements are: You have no insurance coverage for outpatient prescription drugs, nor do you qualify for a government program that provides for prescription medication, e.g. Medicaid. Your income is at a level that causes a hardship when you are required to purchase the medication at retail. Your income must fall within the limits established by each pharmaceutical company (The limits vary according to the company).

The Medicine Program

has a $5 processing fee, payable to http://www.themedicineprogram.com. To request a brochure call (573) 996-7300.

NeedyMeds

This is an online database of companies and the drugs they offer free of charge. Go to http://www.needymeds.com

Indigent Patient Services, Inc.,

(IPS) works to facilitate the process required to access patient assistance programs sponsored by pharmaceutical manufacturers. It researches available drug assistance programs and works directly with your healthcare provider to determine your eligibility. IPS - 440 13th Ave. No., St. Petersburg, Florida 33701 Phone: (727) 821-7333, Fax: (727) 898-0004, E-mail : [email protected]

National Organization of Rare Diseases (NORD)

Medication Assistance Programs Through the NORD Patient Assistance Program, eligible patients are provided with cost-free medications, or, in some cases, subsidy relief is given for high health insurance co-payments. Please visit www.rarediseases.org for more information. NORD also administers Early Access Programs for investigational new drugs (INDs) under the Food and Drug Administration's approved "Treatment-IND" programs that allow for a limited number of individuals to receive certain investigational drugs prior to FDA marketing approval.

Assistive Devices

Silver Cross

This is a free information service that can help you find a recycled or new, low-priced product, including:

Ceiling lifts
Home residential elevators
Incline wheelchairs/lifts
Patient lifts
Vertical wheelchair lifts
Scooter lifts
Bath lifts
Electric wheelchairs
Lift chairs
Hospital beds
Stair lifts
Electric scooters

For more information, go to www.silvercross.com







FREQUENTLY ASKED QUESTIONS



How can I use this pamphlet to obtain medication that has been prescribed to myself or a family member?

Find the name of the manufacturer Read the information about the companys program. If you think you may be eligible for one of these programs, then speak to your physician. Most programs require that your physician make the initial contact with the manufacturer. If the patient is determined eligible, in most cases, the manufacturer will send the medication to the physicians office where it will be distributed.


How do I know if I am eligible for one of these programs?

Since these programs are voluntarily developed by manufacturers, each company determines their own eligibility criteria. Many programs simply require that the physician determine that the patient cannot afford the drugs prescribed. Other programs, especially those for very expensive drugs, require a patient to meet certain income or asset criteria. Private health insurance, third-party coverage, Medicaid, or Medicare may disqualify you from an indigent patient program.


What if the medication I need is not listed in this publication?

Not all medications are available through these programs. However, new programs and new drugs are continually being developed. You may wish to contact the manufacturer directly to inquire about other programs that may be available. For numbers of companies not listed here, you may consult a Physician s Desk Reference (PDR) found at many local libraries.

What if my physician will not enroll me in a patient assistance program?

Since these are not government funded programs, and physicians do not receive reimbursement for providing this service, certain physicians may decline participation in these programs. In this case you may wish to consult with another doctor or check if the program you wish to participate in has a special patient number you can use to enroll yourself.


Directory Of
Pharmaceutical Manufacturers
Indigent Patient Programs


ADRIA LABORATORIES, INC.
Contact:
Adria Laboratories
Patient Assistance Program
P.O. Box 9525, McLean, VA 22102;
1-800-366-5570
Adriamycin PFS, Adrucil, Folex, Idamycin, Neosar, Tarabine, and Vincasar.
Two months' supply. Physician must certify patient is unable to afford the cost of the drug, and is unable to obtain assistance elsewhere.
ALLERGAN PRESCRIPTION PHARMACEUTICALS
Contact:
Allergan Patient Assistance Program
2525 Dupont Drive, Irvine, CA 92713;
1-800-347-4500 Ext. 4280
Betagan, Bleph-10, Epifrin, FML, HMS, Oculinium, Pilagan, Propine, and some OTC tear products.
Course of therapy, up to a maximum of 6 months' supply. Eligibility criteria are at the physician's discretion.
AMGEN, INC.
Contact:
Amgen Safety Net Programs,
Medical Technology Hotlines;
1-800-272-9376;
202-637-6698 in Washington, D.C.
EPOGEN and NEUPOGEN.
Amgen's program consists of a universal patient program and a variable cap program 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 Reimbursement) Program;
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
PHARMACEUTICALS, INC.

Contact:
PARTNERS IN HEALTH;
1-800-556-8317.
Persantine, Atrovent, Alupent, and 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
Contact:
Bristol-Myers Squibb Patient Assistance Program
P.O. Box 9445, McLean, VA 22102-9998;
1-800-736--0003; 703-760-0049 (FAX).
Duricef, Cefzil, BuSpar, Desyrel, Estrace, Ovcon-35, Ovcon-50, Natalins, Natalins RX, Vagistat-1, and Mycostatin Physician's request.
BRISTOL-MYERS SQUIBB
(Cancer Patient Access Program)
Contact:
Bristol-Myers Squibb Cancer Patient Access Program,
2400 West Lloyd Expressway, Evansville, IN 47721;
Mail Code R-22;
1-800-437-0994
BICNU, CEENU, Lysodren, Mutamycin, Mycostatin Pastilles, Paraplatin, Platinol, Platinol-AQ, VePesid, Blenoxance, Cytoxan, Lyophilized Cytoxan, Ifex, Mesnex, and Megace Two months' supply. Internal financial screening on a case-by-case basis.
BURROUGHS-WELLCOME
Contact:
Patient Assistance Program, Burroughs-Wellcome Co.
P.O. Box 52035, Phoenix, AZ 85072-9349;
1-800-722-9294 (Program Enrollment).
Septra, Septra DS, Lanoxin, Mepron, AZT(Retrovir), Zovirax, Zyloprim, Imuran, and WellcovorinThe products are available in a 30-day supply, with maximum of 90 days therapy. Eligibility criteria that have to be met:
1) All applications will be reviewed within established criteria and on a case-by-case basis.
2) Patients must be residents of the United States or territories.
3) All alternative funding sources must be investigated.
4) All required information must be provided for consideration of eligibility.
5) Patients may be approved (occasionally) by exception if extreme extenuating circumstances exist.
CIBA-GEIGY PHARMACEUTICAL
(Patient Support Program)
Contact for the program:
Jackie LaGuardia, Senior Information Assistant,
Ciba-Geigy Corporation
556 Morris Ave. D2058, Summit, NJ 07901;
1-800-257-3273
All the companies products (including those distributed by Basal and Summit) are covered under the program, which include Actigall, Anafranil, Anturane, Apresazide, Apresoline, Aredia, Brethaire, Brethine, Cataflam, Cytadren, Desferal, Esidrix, Esimil, Estraderm, Habitrol, Ismelin, Lamprene, Lioresal, Lopressor, Lotensin, Slow-K, Tegretol, and Transdermal-Nitro. Ritalin, a controlled substance, is not covered under this program. Up to 3 months' supply available.
DU PONT MERCK PHARMACEUTICAL CO.
Contact:
Darlene Samis
Du Pont Pharma,
P.O. Box 80026, Wilmington, DE 19880-0026;
1-800-474-2762
Drugs covered: Coumadin, Lodosyn, Sinemet, Sinemet CR, Symmetrel, Trexan, and Vaseretic. Controlled substances are not covered, which include Percodan and Percocet. Thirty days supply. The patient must be indigent and ineligible fora Federal or State Government pharmaceutical assistance program.
GENENTECH, INC.
Contact:
Genentech, Inc.
P.O. Box 2586, S. San Francisco, CA 94083-2586;
1-800-879-4747
Protropin (Human Growth Hormone), Activase (TPA, Tissue Plasminogen Activator), Actimmune (Interferon Gamma-lb), and Nutropin. 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 gross family income of $25,000 or less, the company provides replacement product to the hospital.)
GLAXO, INC.
Contact:
Laura N. Wright, Supervisor
Glaxo Indigent Patient Program
Glaxo, Inc.
P.O. Box 13438, Research Triangle Park, NC 27709;
1-800-452-9677; 919-248-7971 (FAX)
Zantac, Ceftin, Ventolin, Beconase, Beconase AQ, and 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:
HRPI Patient Access Program
Field Forest Development;
1-800-422-4779
Products include Altrace, ALT/S, Claforan, Diabeta, Lasix, Loprox, and Trental. 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-LaROCHE, INC.
Contact:
Daria Osborne, Director
Medical Needs Program
Roche Laboratories
340 Kingsland Street, Nutley, NJ 07110;
1-800-285-4489; 201-235-2765 (FAX)
They do not accept faxed applications. Valium, Librium, Limbritol, Dalmane, Hivid, Bactrim, Bactrim DS, Klonopin, Efudex (Fluorouracil Injectable), Gantrisin, Gantanol, Interferon 2A Recombinant, Rocephin Injectable, and 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
1-800-466-8639; 206-587-0430
Leukine 250 mcg., Leukine 500 mcg, Hydraea, and 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 PHARMACEUTICA
Contact:
Janssen Patient Assistance Program
1800 Robert Fulton Drive, Reston, VA 22091;
1-800-544-2987
Ergamisol (levamisole HCI), Hismanal, Imodium, Nizoral, Sporanox, Duragesic, and Vermox. 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 PHARMACEUTICAL CO. Contact:
Knoll Pharmaceutical Indigent Patient Program
30 N. Jefferson Road, Whippany, NJ 07981;
1-800-524-2474
Isoptin, Rythmol, and Santyl. 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. Eligible if financially indigent and not insured.
LEDERLE LABORATORIES
Contact:
Lederle Partners and Patient Care;
1-800-533-2273
Diamox, Artane, Minocin, Leucovorin, Calcium Loxapine, Verelan, Rheumatrex, Maxzide, and Myambutol. Physician has to make the request. Patients have to be financially indigent, and not eligible for coverage under third-party insurance or Medicaid reimbursement.
ELI LILLY AND COMPANY
Contact:
Lilly Cares, Patient Assistance Program
P.O. Box 9105, McLean, VA 22102-0105;
1-800-545-6962
Ceclor, Keflex, Prozac, Dymelor, Axid and the insulin products Humulin and Iletin. The program does not cover controlled substances, which include Darvon and Darvocet products. Quantities are dependent upon the product and the physician's instructions. Patient's 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 8600, Kansas City, MO 64114;
1-800-362-7466
Cardizem, Cardizem CD, Cardizem SR, Carafate, Pavabid, Seldane, Seldane D, Nicorette, Quinamm, and Lorelco. Three months' supply. The physician determines whether the patient is eligible for the program. Eligibility also based on income level and lack of insurance.
McNEIL PHARMACEUTICAL
Contact:
Thomas Schwend, Manager
Medical Information,
McNeil Pharmaceutical Corporation
P.O. Box 300, Route 202 South, Raritan, NJ 08869-0602;
1-800-682-6532
Pancrease, Parafon Forte DSC, Haldol, Vascor, and Tolectin. 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 request, accompanied by a signed and dated prescription and letter stating financial status and need of patient.
MERCK & COMPANY, INC.
Contact:
Patient Assistance Program,
Merck & Co., Inc.
P.O. Box 4-WP35-258, West Point, PA 19486-0004;
215-652-5000 (collect calls accepted)
Merck products covered include Mevacor, Plendil, Pepcid, Prilosec, Prinivil, Proscar, Timoptic, Timolol, Clinoril, Flexeril, Periactin, Noroxin, Cogentin, Indocin, Aldomet, Dolobid, Vasoretic, and Vasotec; except injectables. Physicians only can call and request applications.
MILES PHARMACEUTICALS
Contact:
Miles Indigent Patient Program
400 Morgan Ave. West Haven, Connecticut 06516;
1-800-998-9180
Cipro, Nimotop, and 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 guidelines.
ORTHO BIOTECH INC.
Contact:
Ortho Biotech Financial Assistance Program
1800 Robert Fulton Drive, Reston, VA 22091-4345;
1-800-553-3851
Assistance programs are for PROCRIT (Epoetin alfa) and LEUSTATIN (cladribine)Injection
Programs criteria:
1) 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 uninsured or cannot afford the cost of their treatment.
2) Cost Sharing Program 1-800-441-1366 limits the annual cost of PROCRIT expenditures for a patient exceeding approximately $8,500 for a calendar year, regardless of third- party coverage.
3) LEUSTATIN Financial Assistance Program 1-800-447-3437 provides LEUSTATIN therapy free of charge to all persons who meet specific criteria and lack financial resources and third-party insurance necessary to obtain treatment.
ORTHO PHARMACEUTICALS
Contact:
Thomas Schwend, Manager, Medical Information
Ortho Pharmaceutical Corporation
P.O. Box 300, Route 202 South, Raritan, NJ 08869-0602;
1-800-682-6532
Floxin, Aci-jel, Ortho Dienestrol Cream, Monistat Vaginal Suppositories, Protostat Tablets, Sultrin Triple Sulfa Cream, Sultrin Triple Sulfa Vaginal Tablets, Terazol3 Suppositories, Terazol 7 Cream, Spectazole Cream, Monistat-DermCream, Grifulvin Suppositories, Meclan Cream, Persa-gel, Persa-gelW, and Erycette. Varies by product, patient condition. Physician determines that patient is indigent and not eligible for health insurance. Physician 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.
PARKE-DAVIS
Contact:
Parke-Davis Patient Assistance Program
P.O. Box 9945, McLean, VA 22102;
1-800-755-0120
All products are made available which include Accupril, Cognex, Dilantin, Lopid, Neurontin, Nitrostat, Pyridium, Procan, Sublingual and 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 and financial status.
PFIZER, INC. PROGRAM #1
Contact:
Pfizer Indigent Patient Program
P.O. Box 25457, Alexandria, VA 22314-5457;
1-800-646-4455
Antivert, Marax, Diabinese, Cardura, Minizide, Navane, Sinequan, Feldene, Procardia, Procardia YL, Vibramycin, Vistaril, Zoloft, Minipress, Minizide, and 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 takes three to four weeks to receive medication. Refills are available upon request by doctor.
PFIZER, INC.
PROGRAM #2:
ROERIG DIVISION

Contact:
Diflucan Patient Assistance Program
1-800-869-9979
Diflucan (Fluconazole). Up to three months' supply at one time and then can reapply. Patient must not have insurance or other third-party coverage, including Medicaid. Patient must not be eligible for a state AIDS drug assistance program. Patient must have an income of less than $25,000 a year without dependents; or less than $40,000 a year with dependents.
PROCTER & GAMBLE PHARMACEUTICALS, INC.
Contact:
Procter & Gamble Pharmaceuticals, Inc.
17 Eaton Avenue, Norwich, NY 13815;
1-800-448-4878
Asacol, Dantrium, Didronel, Macrobid, and Macrodantin. The quantity varies depending upon the situation, but at least a one month supply can be obtained upon receipt 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
Contact:
Patient Support Program
R&D Laboratories, Inc.
4094 Glencoe Avenue, Marina del Rey, CA 90292;
1-800-338-9066
Every R&D Laboratories pharmaceutical nutritional supplement has a special Indigent Patient Program sticker. Patients bring the stickers 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 PHARMACEUTICALS
Contact:
Sandoz/NORD Drug Cost Share Program
P.O. Box 8923, New Fairfield, CT 06812;
1-800-447-6673 (for all drugs)
The National Organization for Rare Disorders (NORD)/Sandoz Drug Cost Share Program (DCSP) is solely administered by NORD. Sandimmune, Sandostatin, Parlodel, Lescol, DynaCirc and Eldepryl are covered under one program. Clozaril is covered under a different program, as described below. Patient is awarded up to one year's supply of drug, which is shipped in three month supplies via the mail-order mpharmacy 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 PHARMACEUTICALS
Contact:
Sanofi Winthrop Pharmaceutical Needy Patient Program
Product Information Department
90 Park Avenue, New York, NY 10016;
212-907-2000; 1-800-446-6267 (Push #1 twice when automated answering machine picks up)
Aralen, Breonesin, Bronkometer, Drisdol, Isuprel, Mytelase, NegGram, Primaquine, Plaquenil, and Danocrine. One unit or one month's supply, as required. 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 Intron/Eulexin Products:
Service Program
Schering Laboratories
2000 Galloping Hill Road, Building K-5-2B2, Kenilworth, NJ 07033.
For other Schering Products:
Drug Information Services
Indigent Program; 1-800-521-7157. Intron A-Initial supply is 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. Other Schering products, which include Trinalin, Lotrimin, Lotrisone, Diprosone, Diprolene, Fulvicin, Proventil, Vancenase, Normodyne, and Optimine, are provided for an initial three months' supply, with renewals available for up to three months at a time. Patient eligibility is determined on a case-by-case basis, on internal criteria. The consultation includes a review of the specific case as well as the availability of other means of health care assistance.
SEARLE
Contact:
Patients in Need Foundation
5200 Old Orchard Road, Skokie, IL 60077;
1-800-542-2526
Drugs provided include Aldactazide, Aldactone, Calan, Calan SR, Cytotec, Kerlone, Maxaquin, Norpace, and Norpace CR. Supply is based on the physician's assessment of the needs of 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.
SMITHKLINE BEECHAM: PROGRAM #1
Contact:
SB Access to Care Program
SmithKline Beecham Pharmaceuticals
One Franklin Plaza-FP1320, Philadelphia, PA 19101;
1-800-546-0420 (patient requests) 215-751-5722 (physician requests)
Tagamet, Augmentin, Relafen, Dyazide, Compazine, Bactroban, Amoxil, Ridaura, all other Smith Kline 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. Patient's prescription qualifies only if it is not already covered under private insurance.
SMITHKLINE BEECHAM: PROGRAM #2
Contact:
Eminase/Kytril/Triostat Compassionate Care Programs
SmithKline Beecham Pharmaceutical
One Franklin Plaza-FP1320, Philadelphia, PA 19101;
1-800-866-6273
Eminase and Triostat. Patient 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, and persons 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 Application Form with any one of the following documents: a copy of the patient's medical record, 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 patient programs:1-800-822-8255
Cytovene (ganciclovir sodium) 500mg sterile powder. The company's other products include Naprosyn, Anaprox, Cardene, Synalar, Synemol, Ticlid, Toradol, Lidex, and Nasalide. Up to 25 vials of Cytovene are available. Syntex provides Cytovene free of charge when it is prescribed for an immuno-compromised 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 the drug. For information regarding other Syntex products call 1-800-822-8255.
THE UPJOHN COMPANY
Contact:
Patient Assistance Program
Upjohn Company
1-800-242-7014
Health Care Professionals should contact their local Upjohn Representative. Ansaid, Motrin, Provera, E-Mycin, Halcion, Xanax, Medrol, Cleocin, Lincocin, Loniten, Micronase, Orinase, and Tolinase. Generally, a three months' supply is provided. However, a physician can request a supply for a longer period of time. The physician determines the patient's needs, and if insurance or other social programs to help provide medications are available.
WYETH-AYERST LABORATORIES #1
Contact:
John E. James
Wyeth-Ayerst Laboratories Indigent Patient Program
555 East Lancaster Avenue, St. Davids, PA 19087;
1-800-568-9938
Sectral, Cyclospasmol, Premarin, Isordil, Phenergan, Orudis, Wytensin, and Cordarone. The company also makes three oral contraceptives: Triphasil, Lo/Ovral, and Nordette, which are primarily provided by family planning clinics. In general, one to two months' supply or the closest 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:
Norplant Foundation
P.O. Box 25223, Alexandria, VA 22314;
1-703-706-5933.
Norplant (levonorgestrel implants) five year contraceptive system. Eligibility determined 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, Program Director,
Zeneca Pharmaceuticals Group
P.O. Box 15197, Wilmington, DE 19850-5197;
1-800-424-3727.
Nolvadex, Zestoretic, Sorbitrate, Tenormin, Tenoretic, and Zestril. One to three months' supply with application.

ALPHABETICAL LISTING BY DRUG

This section identifies the name of medications frequently prescribed for older Americans and the manufacturers of the drugs which are covered under an indigent patient program listed in this directory. If a drug that you take is NOT listed here, it still my be provided under an indigent patient program; it is suggested that your physician call the company to determine if it is covered under a program. If the manufacturer of a particular drug is not listed in this directory, it is suggested that the patient or physician call the company directly to determine if the company has an indigent patient program. Drug Manufacturer telephone numbers can be found in the Physician's Desk Reference.

DRUG / MANUFACTURER


A
Aci-Jel/Ortho
Actigall/Ciba-Geigy
Actimmune/Genentech
Activase/Genentech
Adriamycina PFS/Adria
Adrucil/Adria
Aldactone/Searle
Aldomet/Merck
ALT/S/Hoechst-Roussel
Altace/Hoechst-Roussel
Alupent/Boehringer
Anafranil/Ciba-Geigy
Anaprox/Syntex
Ansaid/Upjohn
Antivert/Pfizer #1
Anturane/Ciba-Geigy
Anusol HC/Parke-Davis
Apresazide/Ciba-Geigy
Apresoline/Ciba-Geigy
Aralen/Sanofi Winthrop
Aredia/Ciba-Geigy
Artane/Lederle
Asacol/Procter & Gamble
Atrovent/Boehringer
Augmentin/SmithKline
Axid/Eli Lilly
AZT (Retrovir)/Burroughs-Wellcome

B
Bactrim DS/Hoffman-LaRoche
Bactroban/SmithKline
Beconase/Glaxo
Beconase AQ/Glaxo
Betagan/Allergan
BICNU/Bristol-Myers #3
Blenoxance/Bristol-Myers #3
Bleph-10/Allergan
Breonesin/Sanofi Winthrop
Brethaire/Ciba-Geigy
Bronkometer-Sanofi Winthrop
BuSpar/Bristol-Myers #1

C
Calan/Searle
Calan SR/Searle
Capoten/Bristol-Myers #2
Capozide/Bristol-Myers #2
Carafate/Marion Merrell Dow
Cardene/Syntex
Cardizem/Marion Merrell Dow
Cardura/Pfizer #1
Carnitor/Sigma-Tau
Cataflam/Ciba-Geigy
Catapres/Boehringer
Ceclor/Eli Lilly
CEENU/Bristol-Myers #3
Ceftin/Glaxo
Cefzil/Bristol-Myers #1
Cipro/Miles
Claforan/Hoechst-Roussel
Clinoril/Merck
Clozaril/Sandoz
Cogentin/Merck
Compazine/SmithKline
Cordarone/Wyeth-Ayerst
Corgard/Bristol-Myers #2
Corzide/Bristol-Myers #2
Coumadin/DuPont Merck
Cyclospasmol/Wyeth-Ayerst
Cytadren/Ciba-Geigy
Cytotec/Searle
Cytovene/Syntex
Cytoxan/Bristol-Myers #3

D
Dalmane/Hoffman-LaRoche
Danocrine/Sanofi Winthrop
Dantrium/Procter & Gamble
Desferal/Ciba-Geigy
Desyrel/Bristol-Myers #1
Diabeta/Hoechst-Roussel
Diabinese/Pfizer #1
Diamox/Lederle
Didronel/Procter & Gamble
Dienestrol/Ortho
Diflucan/Pfizer #2
Dilantin/Parke-Davis
Diprolene/Schering-Plough
Diprosone/Schering-Plough
Dolobid/Merck
Drisdol/Sanofi Winthrop
Duricef/Bristol-Myers #1
Dyazide/SmithKline #1
Dymelor/Eli Lilly
DynaCirc/Sandoz

E
E-Mycin/Upjohn
Efudex(Fluorouracil Inj)/Hoffman
Eldepryl/Sandoz
Eminase/SmithKline #2
Epifrin/Allergan
Epogen/Amgen
Ergamisol/Janssen
Erycette/Ortho
Esidrix/Ciba-Geigy
Esimil/Ciba-Geigy
Estrace/Bristol-Myers #1
Eulexin/Schering-Plough
Extel/Procter & Gamble

F
Feldene/Pfizer #1
Flexeril/Merck
Floxin/Ortho
FML/Allergan
Foscavir/Astra
Fulvicin/Schering-Plough

G
Glucotrol/Pfizer #1

H
Habitrol/Ciba-Geigy
Halcion/Upjohn
Haldol/McNeil
Hismanal/Janssen
Hivid/Hoffman-LaRoche
HMS/Allergan
Hytakerol-Sanofi Winthrop

I
Idamycin/Adria
Ifex/Bristol-Myers #3
Imodium/Janssen
Imuran/Burroughs-Wellcome
Indocin/Merck
Insulin Humulin and Ilentin/Eli Lilly
Interferon-A Recomb/Hoffman
Intron-A/Schering-Plough
Ismelin/Ciba-Geigy
Isoptin/Knoll
Isordil/Wyeth-Ayerst
Isuprel/Sanofi Winthrop

K
K-Lyte/Bristol-Myers #1
Keflex/Eli Lilly
Kerlone/Searle
Klonopin/Hoffman-LaRoche
Klotrix/Bristol-Myers #2

L
Lamprene/Ciba-Geigy
Lanoxin/Burroughs-Wellcome
Lasix/Hoechst-Roussel
Lescol/Sandoz
Leucovorin Calcium/Lederle
Leukine/Immunex
Librium/Hoffman-LaRoche
Limbritol/Hoffman-LaRoche
Lioresal/Ciba-Geigy
Lithobid/Ciba-Geigy
Lo/Ovral/Wyeth-Ayerst
Lodosyn/DuPont-Merck
Lopid/Parke-Davis
Lopressor/Ciba-Geigy
Loprox/Hoechst-Roussel
Lotensin/Ciba-Geigy
Lotrimin/Schering-Plough
Lotrisone/Schering-Plough
Loxapine/Lederle
Ludiomil/Ciba-Geigy
Lyophilized Cytoxan/Bristol-Myers #3

M
Macrobid/Procter & Gamble
Macrodantin/Procter & Gamble
Maxzide/Lederle
Medrol/Upjohn
Megace/Bristol-Myers #3
Mepron/Burroughs-Wellcome
Mesnex/Bristol-Myers #3
Mevacor/Merck
Micronase/Upjohn
Minipress/Pfizer #1
Minocin/Lederle
Monistat/Ortho
Monistat-Derm/Ortho
Monopril/Bristol-Myers #2
Motrin/Upjohn
Myambutol/Lederle
Mycostatin/Bristol-Myers #1
Mytelase/Sanofi Winthrop

N
Naprosyn/Syntex
Nasalide/Syntex
Natalins RX/Bristol-Myers #1
NegGram/Sanofi Winthrop
Neosar/Adria
Neupogen/Amgen
Neurontin/Parke-Davis
Nicorette/Marion Merrell Dow
Nimotop/Miles
Nizoral/Janssen
Nolvadex/Zeneca
Nordette/Wyeth-Ayerst
Normodyne/Schering-Plough
Noroxin/Merck
Norpace/Searle
Norplant System/Wyeth-Ayerst
Nutropin/Genentech

O
Oculinium/Allergan
Optimine/Schering-Plough
Orinase/Upjohn
Orudis/Wyeth-Ayerst
Ovcon/Bristol-Myers #1

P
Pancrease/McNeil
Parafon Forte DSC/McNeil
Paraplatin/Bristol-Myers #3
Parlodel/Sandoz
Pavabid/Marion Merrell Dow
PBZ/Ciba-Geigy
Pepcid/Merck
Periactin/Merck
Persa-Gel/Ortho
Persantine/Boehringer
Phisohex/Sanofi Winthrop
Pilogan/Allergan
Plaquenil/Sanofi Winthrop
Platinol/Bristol-Myers #3
Plendil/Merck
Ponstel/Parke-Davis
Pravochol/Bristol-Myers #2
Premarin/Wyeth-Ayerst
Prilosec/Merck
Primaquine/Sanofi Winthrop
Prinivil/Merck
Procan/Parke-Davis
Procardia/Pfizer #1
Procrit/Ortho Biotechnology
Prokine/Hoechst-Roussel
Pronestyl SR/Bristol-Myers #2
Propine/Allergan
Propulsid/Janssen
Proscar/Merck
Prostat/Ortho
Protropin/Genentech
Proventil/Schering-Plough
Provera/Upjohn
Prozac/Eli Lilly
Pyridium/Parke-Davis

Q
Questran/Bristol-Myers #2
Quinamm/Marion Merrell Dow

R
Regitine/Ciba-Geigy
Relafen/SmithKline
Rheumatrex/Lederle
Rimactane/Ciba-Geigy
Risperdal/Janssen #1
Rocaltrol/Hoffman-LaRoche
Rocephin/Hoffman-LaRoche
Rythmol/Knoll

S
Sandimmune/Sandoz
Sandoglobulin/Sandoz
Sandostatin/Sandoz
Santyl/Knoll
Sectral/Wyeth-Ayerst
Septra DS/Burroughs-Wellcome
Seldane/Marion Merrell Dow
Sinemet/DuPont-Merck
Sorbitrate/Zeneca
Spectazole/Ortho
Sporanox/Janssen
Sultrin/Ortho
Symmetrel/DuPont Merck
Synalar/Syntex
Synemol/Syntex

T
Tagamet/SmithKline
Tarabine/Adria
Tenormin/Zeneca
Terazol/Ortho
Timolol/Merck
Timoptic/Merck
Tofranil/Ciba-Geigy
Tolectin/McNeil
Topicort-Hoechst-Roussel
Trancopal/Sanofi Winthrop
Trandate/Glaxo
Trental/Hoechst-Roussel
Trexan/DuPont-Merck
Tridesilon Cream/Miles
Triostat/SmithKline #2
Triphasil/Wyeth-Ayerst

V
Vagistat/Bristol-Myers #l
Valium/Hoffman-LaRoche
Vascor/McNeil
Vasodilan/Bristol-Myers #3
Vasoretic/Merck
Vasotec/Merck
VePesid/Bristol-Myers
Verelan/Lederle
Vermox/Janssen
Vincasar/Adria
Voltaren/Ciba-Geigy

W
Wellcovorin/Burroughs-Wellcome
Wytensin/Wyeth-Ayerst

X
Xanax/Upjohn

Z
Zantac/Glaxo
Zestoretic/Zeneca
Zestril/Zeneca
Zoloft/Pfizer #1
Zovirax/Burroughs-Wellcome
Zyloprim/Burroughs-Wellcome





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