Programas de asistencia al paciente para Clozapine

Solicite apoyo para su receta con Clozapine

Si califica, los programas a continuación le pueden ser útiles para conseguir clozapine. Revise la información para saber si califica. Las solicitudes están disponibles en formato PDF y deben enviarse directamente a quien proporciona el programa de asistencia al paciente.

Si tiene alguna pregunta favor de comunicarse al teléfono para el programa correspondiente (no PharmacyChecker.com), o vaya a la página del programa.

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Mylan Clozapine Patient Assistance Program (MCPAP)

(Programa 1 de 2 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: Mylan Pharmaceuticals, Inc.
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
FAX: 877-427-7290
Idiomas hablados:
English, Spanish
La Página del Programa
Solicitudes y Formularios
Medicamentos
  • None (clozapine)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Solicitud
  • Obtaining Call
  • Receiving Faxed, emailed or mailed
  • Returning The completed application can be faxed, mailed or emailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified in writing
  • Decision Timeframe Within 2 weeks
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Pharmacy
  • Delivery Time Contact Program for Details
  • Refill Proces Automatically sent out
  • Limit Not specified
  • Re-application New application every 6 months
Información Adicional
There are two steps and two sets of paperwork for this program. The first step is to register the patient, which is required for any patient taking Clozapine, regardless of insurance or financial situations. Call 800-843-9915 to register. This is a two-page form that the patient, physician and pharmacist must fill out.
Actualizado March 21, 2019

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TEVA Patient Assistance Program (Clozapine)

(Programa 2 de 2 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: TEVA Pharmaceuticals
PO Box 52028 Phoenix, AZ 85072
TEL: 877-237-4881
FAX: 877-438-4404
Idiomas hablados:
English
La Página del Programa
Medicamentos
  • None (clozapine)
Requisitos de Elegibilidad
  • Insurance Status No insurance coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Must provide diagnosis code
  • U.S. Residency Required? Must be a US resident
Solicitud
  • Obtaining Call
  • Receiving Faxed, emailed or mailed
  • Returning The completed application can be faxed, mailed or emailed back.
  • Doctor's Action Complete section, sign; attach lab results
  • Applicant's Action Complete section and sign
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within 2 weeks
Medicamento
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Once approved; within 2 business days
  • Refill Proces Doctor must fax current lab results to company
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
None
Actualizado March 1, 2019

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