RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

NOVARTIS PHARMACEUTICALS CORPORATION
Novartis Patient Assistance Foundation, Inc.

Focalin XR (dexmethylphenidate hcl)
 
CONTACT INFO
Address: PO Box 66556
St. Louis, MO 63166-6556
Phone: 1-800-277-2254 Provider Phone:
Fax: 1-855-817-2711 Website: Novartis Patient Assistance Foundation Program Website
ELIGIBILITY
Eligibility Info:
  • To be eligible for this program, patients must be a U.S. Resident, meet the income requirements, and must not have prescription drug coverage.
  • Medicare beneficiaries who enroll in a Part D plan may be considered for the Novartis Patient Assistance Foundation Program (NPAFP) based upon the following criteria:

    * Patients on Novartis transplant or oncology products who enroll in a Part D plan can continue to receive help through NPAFP as long as they continue to meet eligibility criteria for NPAFP, do not qualify for the LIS, and show financial hardship in affording their medications despite the Part D benefit coverage;

    * Other cases will be evaluated individually, based on the particular Novartis product, specific circumstances and financial hardship experienced.
  • 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
    Prescription
    Physician License #
    Required:
    Either DEA or State
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    For some medications such as Focalin XR and Ritalin LA, a pharmacy card will be sent to the patient. The patient must take the pharmacy card and a valid prescription to their retail pharmacy to receive the product.
    Shipped To: Provider
    Note: For Clozaril, Focalin XR and Ritalin LA the patient will receive a pharmacy card.
    Quantity in Shipment: 90 days
    Some medications are sent in 30 day or 90 day supplies.
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: 3 refills
    Program has an automated refill system.
    Other Information:

    Last Updated: 07/17/2014

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)


    Document Instructions (English)


    Document Instructions (Spanish)



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2012, RxVantage, all rights reserved.