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

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Bayer Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Bayer HealthCare Pharmaceuticals Inc.

PO Box 5670
Louisville, KY 40255

TEL: 866-575-5002

ALT PHONE: 877-422-7709
FAX: 866-575-6568
Languages Spoken:


Program Website


Program Applications and Forms

Bayer Patient Assistance Program Application



  • Angeliq tablet (drospirenone/estradiol)

Eligibility Requirements   

Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be residing in the US or Puerto Rico


Obtaining Call
Receiving Sent to doctor or patient
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Doctor notified via mailed letter
Decision Timeframe Not specified


Amount/Supply Up to 90 day supply
Sent To Doctor's office or patient's home
Delivery Time Within 7-10 business days
Refill Process Doctor/Doctor's office must complete replacement form
Limit Not specified
Re-application New application, new documentation yearly

Additional Information

Eligibility determined on a case-by-case basis.

Updated March 23, 2018