Lotronex Patient Assistance Programs

Lotronex: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Lotronex. 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?

Sebela Patient Assistance Program (Lotronex & Ridaura)

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

Provided by: Sebela Pharmaceuticals Inc.
PO Box 219 Gloucester, MA 01931
TEL: 866-562-7902
FAX: 888-246-6527
Languages Spoken:
English
Program Website
Medications
  • Lotronex (alosetron)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case. *See Additional Information Section Below
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
Application
  • Obtaining Call or download
  • Receiving Faxed, emailed, mailed or downloaded
  • Returning The completed application can be faxed, mailed or emailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified by email or phone
  • Decision Timeframe 5-7 business days
Medication
  • Amount/Supply Contact the program for more details.
  • Sent To Doctor's office or patient's home
  • Delivery Time Once approved; shipped next business day
  • Refill Proces Patient or Doctor's office needs to contact company
  • Limit None
  • Re-application New prescription every 3 months. New application every 6 months.
Additional Information
* Must not have Health insurance coverage (private or government) that pays for requested products and haven’t for at least three months. **Medicare Part D - Copy of insurance denial letter required. ***The manufacturer supporting this program does not charge for applying to the program nor for any products applicants receive. Applicants using the services of a commercial advocacy service may have to supply additional documentation. 
Updated July 16, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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