Programas de asistencia al paciente para Lithostat

Solicite apoyo para su receta con Lithostat

Si califica, los programas a continuación le pueden ser útiles para conseguir Lithostat. 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.

¿Está buscando otro tipo de medicamento?

Mission Product Request

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

Provienen de: Mission Pharmacal Company
None
TEL: 877-425-0325
FAX: 877-426-2795
Idiomas hablados:
English, Spanish
La Página del Programa
Solicitudes y Formularios
Medicamentos
  • Lithostat tablet (acetohydroxamic acid tablet)
Requisitos de Elegibilidad
  • Insurance Status Not specified
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? US residency requirements are not specified.
Solicitud
  • Obtaining The Doctor should call for an application or download it from the website
  • Receiving Faxed to Doctor's office
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section and sign
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Not specified
Medicamento
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Doctor contacts company
Información Adicional
Resources for HEALTHCARE PROFESSIONAL ONLY. The Doctor must contact the program to place an order.
Actualizado July 16, 2019

Si usted, su paciente o un ser querido no es elegible para este programa o otros, se pueden encontrar precios de aquí.

Volver al principio

Mission Pharmaceutical Patient Assistance Program

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

Provienen de: Mission Pharmacal Company
None
TEL: 800-292-7364
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Lithostat tablet (acetohydroxamic acid tablet)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? No
  • Income At or below 100% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be a US citizen.
Solicitud
  • Obtaining Doctor's office needs to send letter indicating patient needs this medication, duration, diagnosis, patient name, contact name, phone and fax numbers
  • Receiving Sent to Doctor's office
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach prescription
  • Applicant's Action Not applicable
  • Decision Communicated Doctor notified
  • Decision Timeframe 7-10 business days
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office
  • Delivery Time Within 2 weeks
  • Refill Proces Doctor's office sends copy of letter with new dates and any change in dosage. Must be at least 3 weeks prior to prescription running out. In some cases new application may be needed
  • Limit Not specified
  • Re-application New application every 3 months
Información Adicional
Contact the program for more details (1-800-292-7364).
Actualizado July 16, 2019

Si usted, su paciente o un ser querido no es elegible para este programa o otros, se pueden encontrar precios de aquí.

Volver al principio