| |
Program Details
BAYER HEALTHCARE PHARMACEUTICALS
Bayer Patient Assistance Program for Precose
Precose
(acarbose
)
|
| CONTACT
INFO |
|
| Address: |
6 West Belt, W66
Wayne, NJ 07470-6806 |
| Phone: |
1-866-575-5002 |
Provider Phone: |
|
| Fax: |
|
Website: |
|
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
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 resident. Eligibility is determined on a case by case basis. Any patient who is enrolled in any Government Prescription Programs or Private Prescription Plans including, but not limited to Medicare Part D, Medicaid, State-sponsored Prescription Assistance programs, or has employee, military, retirement, or pension program drug coverage is not eligible for this program. Pharmacy discount cards or other patient assistance programs are not considered coverage.
|
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security
# requested on form: |
Not
Published |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Not Published
The patient or doctor should call for an application. The application is sent to the doctor's office.
|
Physician
License #
Required: |
|
Prescriber
Signature
Allowed: |
Not Published
|
Application
may be
faxed: |
Yes |
Eligibility
determination
letter sent: |
Provider
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Provider
|
| Quantity in
Shipment: |
90 days
|
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
3 refills
|
| Other Information: |
|
|
|
Last Updated: 08/11/2010
|
|
Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
Precose Application Form
|
|
