Zoladex Patient Assistance Programs

Zoladex: Apply for prescription assistance below

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

TerSera Therapeutics Patient Assistance Program (Zoladex)

(Program 1 of 2 — Scroll down to see them all )

Provided by: TerSera Therapeutics LLC
PO Box 46 Somerville, NJ 08876
TEL: 844-965-2339
ALT PHONE: 844-965-2339
FAX: 855-836-3066
Languages Spoken:
English
Program Website
Medications
  • Zoladex (goserelin acetate)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or possess a valid greencard to be eligible for this program
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning Fax or mail (Note: faxed prescriptions are only valid if faxed directly from a prescriber's office)
  • 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 Up to 90 day supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Patient or Doctor's office needs to contact company
  • Limit Up to one year
  • Re-application Company contacts patient about reapplying
Additional Information
This program also provides co-pay and reimbursement assistance.
Updated September 17, 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 2 of 2 — 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
  • Zoladex (goserelin acetate)
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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