Program Details
NOVARTIS PHARMACEUTICALS CORPORATION
Universal Co-Pay Card
Sandostatin LAR Depot
(octreotide acetate)
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| CONTACT
INFO |
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| Address: |
, |
| Phone: |
1-877-577-7756 |
Provider Phone: |
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| Fax: |
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Website: |
Program Website |
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| ELIGIBILITY
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| Eligibility
Info: |
This offer is valid only for those with commercial insurance and who have a valid prescription.
This offer is not valid under Medicare, Medicaid, or any other federal or state program, for cash-paying patients, where product is not covered by patient's commercial insurance, or where plan reimburses you for entire cost of your prescription drug. This offer is not valid where prohibited by law and is only valid in the United States and Puerto Rico.
Patient will be responsible for up to the first $25 (specific offer varies by brand) and the program pays the remaining co-pay or coinsurance until you reach the yearly maximum of $15,000. After the program maximum, patient is responsible for the difference. |
| |
Couple |
|
% FPL |
| 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 |
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|
APPLICATION |
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| Attachments
Required: |
None
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Physician
License #
Required: |
Not Required
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Prescriber
Signature
Allowed: |
Not Published
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Application
may be
faxed: |
Not Published
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Eligibility
determination
letter sent: |
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| MEDICATION |
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| Receives: |
Pharmacy Card
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| Shipped To: |
Patient
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| Quantity in
Shipment: |
Not Published
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| Delivery Time: |
Not Published
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| Re-application
Policy: |
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| Refill Policy: |
Patient brings card to pharmacy for refills. |
| Other Information: |
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Last Updated: 04/26/2024
www.RxAssist.org
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