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Program Details
BAYER HEALTHCARE PHARMACEUTICALS
Bayer Patient Assistance Program - Menostar
Menostar
(estradiol transdermal system
)
|
| CONTACT
INFO |
|
| Address: |
6 West Belt, W66
Wayne, NJ 07470-6806 |
| Phone: |
1-866-575-5002 |
Provider Phone: |
|
| Fax: |
1-866-575-6568 |
Website: |
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| ELIGIBILITY
|
|
| Eligibility
Info: |
Patient must not have any private or Government Prescription Programs (other than Medicare Part D) including, but not limited to Medicaid, State-sponsored Prescription Assistance programs, or has employee, military, retirement, or pension program drug coverage.
If the patient recieves benefits from any of the programs above, the Bayer Patient Assistance Program cannot provide medication, even if the benefit program or plan does not cover the full cost of, or places limits on, medications. |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security
# requested on form: |
Yes |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
|
Physician
License #
Required: |
Both DEA and State
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes |
Eligibility
determination
letter sent: |
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|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Provider
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
Not Published
|
| Other Information: |
|
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Last Updated: 08/11/2010
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
Instructions (English)
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