Syprine Patient Assistance Programs

Syprine: Apply for prescription assistance below

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

Bausch Health Patient Assistance Program

(Program 1 of 3 — Scroll down to see them all )

Provided by: Bausch Health Companies, Inc.
None
TEL: 833-862-8727
FAX: 866-777-5705
Languages Spoken:
English, Spanish
Program Website
Medications
  • Syprine (trientine)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Determined case by case
  • Income Based on FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must be a US resident and treated by a US licensed healthcare provider
Application
  • Obtaining Call
  • Receiving Faxed
  • 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 Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit One year
  • Re-application New application yearly
Additional Information
Hardship appeals for patients residing in Puerto Rico will be reviewed on a case-by-case basis. Call for information on the most recent medications as the list is subject to change.
Updated November 12, 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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WD Rx Access Program

(Program 2 of 3 — Scroll down to see them all )

Provided by: Valeant Pharmaceuticals, Inc.
WD Rx Access Program PO Box 220667 Charlotte, NC 28222-0667
TEL: 888-607-7267
FAX: 855-735-4624
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Syprine (trientine)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified by phone
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
This program also provides copay assistance. Please visit www.Cuprimine.com for more information. Please visit www.Syprine.com for more information.
Updated October 15, 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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Patient Access Network Foundation (PAN)

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

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Syprine (trientine)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 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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