Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Romark Laboratories Patient Assistance Program for Alinia

This program provides brand name medications at no or low cost

Provided by: Romark Laboratories

c/o Foundation Care Pharmacy
4010 Wedgeway Court
Earth City, MO 63045

TEL: 855-618-4952


FAX: 855-618-4953
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Romark Laboratories Patient Assistance Program for Alinia Enrollment Form: Contact program

 

Medications

  • Alinia tablet (nitazoxanide)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Must've been denied LIS. Mustn't be eligible for Medicaid
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be treated by US Doctor
   

Application

Obtaining Call
Receiving Faxed, emailed or mailed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 72 hours
   

Medication

Amount/Supply Up to 1 month supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Up to one year
Re-application Not specified
   

Additional Information

Eligibility determined on a case-by-case basis.


Updated July 19, 2017