| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Arestin Rx Access Co-PayFor Healthcare Professionals Only |
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Provided by: Orapharma, Inc. |
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TEL: 855-684-7481FAX: 855-630-9783 |
Languages Spoken:
English |
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Program Applications and Forms |
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Arestin Rx Access Perscription Form |
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| The offer is only valid for patients with private insurance. |
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| Updated July 16, 2018 | |||
