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?

HealthWell Foundation Copay Program

(Program 1 of 2 — 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
  • Lotronex (alosetron)
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 January 3, 2018

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

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Sebela Patient Assistance Program (Lotronex & Ridaura)

(Program 2 of 2 — 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 Lotronex prices here.

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