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

Arestin Rx Access Co-Pay

For Healthcare Professionals Only

Provided by: Orapharma, Inc.


TEL: 855-684-7481


FAX: 855-630-9783 		Languages Spoken:

English

Program Website

 

Program Applications and Forms

Arestin Rx Access Perscription Form

Arestin Rx Access Patient Eligibility Form
 

Medications
  • Arestin powder; extended release (minocycline)
 

Eligibility Requirements   
Insurance Status Must have insurance
Those with Part D Eligible? No
Income Not applicable
Diagnosis/Medical Criteria Must be 18 yr old or older
US Residency Required? Must be treated by US Doctor
   

Application
Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Enroll in program, complete form and obtain patient consent
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication
Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information
The offer is only valid for patients with private insurance.


Updated April 05, 2018