Programas de asistencia al paciente para Sumatriptan

Solicite apoyo para su receta con Sumatriptan

Si califica, los programas a continuación le pueden ser útiles para conseguir sumatriptan. 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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Rx Outreach Medications

(Programa 1 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
  • None (sumatriptan)
Requisitos de Elegibilidad
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income At or below 300% 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 January 8, 2019

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Advanced Patient Services (APS) Program

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

Provienen de: Avanir Pharmaceuticals, Inc.
PO Box 42886 Cincinnati, OH 45242
TEL: 855-468-3339
ALT PHONE: 855-468-3339
FAX: 877-788-4943
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Onzetra Xsail (sumatriptan)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Varies
  • Income At or below 200% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Solicitud
  • Obtaining Call or download
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Varies
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office
  • Delivery Time Within 3-5 business days
  • Refill Proces Doctor/Doctor's office must contact the Program
  • Limit One year
  • Re-application New application every 12 months
Información Adicional
This program also provides co-pay and reimbursement assistance. Please visit www.Nuedexta.com (855-468-3339) & www.Onzetra.com (844-669-3872) for more information.
Actualizado October 2, 2018

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