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

Salix Pharmaceuticals Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Salix Pharmaceuticals

PO Box 66520
St. Louis MO 63166-6520

TEL: 866-282-6563


FAX: 877-738-3694
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Salix Pharmaceuticals Patient Assistance Program Application

 

Medications

  • Anusol-HC cream (hydrocortisone)
  • Anusol-HC suppository; rectal (hydrocortisone acetate)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? Varies
Income At or below 200% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must have a verifiable US or US territory address (no PO Box)
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
Sent To Patient's home
Delivery Time Within 2 weeks
Refill Process Refill/reorder form included with shipment
Limit None
Re-application New application yearly
   

Additional Information

May have Medicare Part D and Must be at or below 500% FPL for Fulyzaq and Xifaxan.


Updated July 12, 2017