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 29061
Phoenix, AZ 85038

TEL: 866-575-5002


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

English

Program Website

 

Program Applications and Forms

Bayer Patient Assistance Program Application

 

Medications

  • 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 citizen or legal resident
   

Application

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
   

Medication

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, 2017