Kyleena Patient Assistance Programs

Kyleena: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Kyleena. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Bayer US Patient Assistance Foundation Free Drug Program

(Program 1 of 5 — Scroll down to see them all )

Provided by: Bayer US Patient Assistance Foundation
PO Box 5670 Louisville, KY 40255
TEL: 866-228-7723
FAX: 866-575-6568
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Kyleena (levonorgestrel)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • 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 Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must complete replacement form
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Eligibility determined on a case-by-case basis.
Updated November 27, 2018

Back to top

Bayer US Patient Assistance Foundation Free Drug Program

(Program 2 of 5 — Scroll down to see them all )

Provided by: Bayer US Patient Assistance Foundation
PO Box 5670 Louisville, KY 40255
TEL: 866-228-7723
FAX: 866-575-6568
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Kyleena (levonorgestrel)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • 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 Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must complete replacement form
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Eligibility determined on a case-by-case basis.
Updated November 27, 2018

Back to top

Bayer US Patient Assistance Foundation Free Drug Program

(Program 3 of 5 — Scroll down to see them all )

Provided by: Bayer US Patient Assistance Foundation
PO Box 5670 Louisville, KY 40255
TEL: 866-228-7723
FAX: 866-575-6568
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Kyleena (levonorgestrel)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • 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 Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must complete replacement form
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Eligibility determined on a case-by-case basis.
Updated November 27, 2018

Back to top

Bayer US Patient Assistance Foundation Free Drug Program

(Program 4 of 5 — Scroll down to see them all )

Provided by: Bayer US Patient Assistance Foundation
PO Box 5670 Louisville, KY 40255
TEL: 866-228-7723
FAX: 866-575-6568
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Kyleena (levonorgestrel)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • 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 Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must complete replacement form
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Eligibility determined on a case-by-case basis.
Updated November 27, 2018

Back to top

HealthWell Foundation Copay Program

(Program 5 of 5 — Scroll down to see them all )

Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • None (levonorgestrel)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 3-5 business days
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Updated November 1, 2018

Back to top