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

TotalCare Otrexup Support Program

This program provides brand name medications at no or low cost

Provided by: Antares Pharma, Inc.

PO Box 325
Florham Park, NJ 07932

TEL: 855-687-3987


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 July 28, 2017