Programas de asistencia al paciente para Qtern

Solicite apoyo para su receta con Qtern

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

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AZ&Me Prescription Savings Program for people with Medicare Part D

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

Provienen de: AstraZeneca Pharmaceuticals
PO Box 222178 Charlotte, NC 28222
TEL: 800-292-6363
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Qtern tablet (dapagliflozin/saxgliptin tablet)
Requisitos de Elegibilidad
  • Insurance Status May have Medicare Part D
  • Those with Part D Elibible? Required
  • Income Varies
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident, green card or work visa holder.
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach proof of income and any insurance information
  • Decision Communicated Patient notified
  • Decision Timeframe Within 2 weeks
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Within 5-7 business days
  • Refill Proces Patient or Doctor must contact company
  • Limit None
  • Re-application Must re-enroll at end of calendar year
Información Adicional
Eligibility determined on a case-by-case basis. *Patients with Medicare Part B coverage may also be eligible. Contact program for details.
Actualizado September 19, 2019

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

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AZ&Me Prescription Savings Program for people without insurance

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

Provienen de: AstraZeneca Pharmaceuticals
PO Box 222178 Charlotte, NC 28222
TEL: 800-292-6363
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Qtern tablet (dapagliflozin/saxgliptin tablet)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income Varies
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident, green card or work visa holder.
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach proof of income and any insurance information
  • Decision Communicated Patient notified in writing
  • Decision Timeframe Within 2 weeks
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Within 5-7 business days
  • Refill Proces Patient or Doctor must contact company
  • Limit None
  • Re-application New application yearly
Información Adicional
People who are in Medicare and may be eligible for the Limited Income Subsidy can apply. However, if they are accepted into the LIS, they are no longer eligible for the AZ& Me Prescription Savings Program. Eligibility determined on a case-by-case basis.
Actualizado September 19, 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

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