Programas de asistencia al paciente para Restoril

Solicite apoyo para su receta con Restoril

Si califica, los programas a continuación le pueden ser útiles para conseguir Restoril. 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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Mallinckrodt Patient Assistance Program

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

Provienen de: Mallinckrodt Pharmaceuticals
Attn: MaxCare PO Box 16430 Oklahoma City, OK 73113
TEL: 800-259-7765, opt. 3
ALT PHONE: 800-259-7765, opt. 3
FAX: 405-213-1521
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Restoril (temazepam)
Requisitos de Elegibilidad
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, if in the donut hole
  • Income At or below 200% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident with a Social Security Number.
Solicitud
  • Obtaining Call
  • Receiving Faxed, emailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified
  • Decision Timeframe Not specified
Medicamento
  • Amount/Supply Up to a 30 day supply or 90 Qty
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
For the medication Roxicodone, the quantity is 360 for the 15mg and 180 for the 30mg. If accepted, the patient must pay a copay of $20.
Actualizado July 11, 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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Rx Outreach Medications

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

Provienen de: Rx Outreach
PO Box 66536 St. Louis, MO 63166-6536
TEL: 888-796-1234
FAX: 800-875-6591
Idiomas hablados:
English, Spanish
La Página del Programa
Medicamentos
  • Restoril (temazepam)
Requisitos de Elegibilidad
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Not required
  • U.S. Residency Required? The patient must also be residing in the US.
Solicitud
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning Fax or E-Prescribe online
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section and sign
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Usually same day
Medicamento
  • Amount/Supply Varies
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Company contacts patient to arrange
  • Limit Only limited by manufacturer's guidelines
  • Re-application New application yearly
Información Adicional
Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s).
Actualizado June 24, 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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