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

TotalCare Otrexup Support Program

For Healthcare Professionals Only

Provided by: Antares Pharma, Inc.


TEL: 855-687-3987


ALT PHONE: 855-820-9605
FAX: 855-820-9608
Languages Spoken:

English Spanish

Program Website

 

Patient Assistance Applications

Otrexup TotalCare Support Enrollment Form

 

Brand Name Medications Covered

 
  • Otrexup
 

Generic Name

 
  • methotrexate
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident
   

Application

Obtaining Doctor/Doctor's office must call, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax or E-Prescribe online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Varies
Delivery Time Not specified
Refill Process Doctor/Doctor's office must contact company
Limit Not specified
Re-application Not specified
   

Additional Information

Eligibility determined on a case-by-case basis.

This program also provides copay assistance.


Updated March 29, 2018