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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Sanofi-Aventis |
| Program Name |
Rilutek Patient Assistance Program |
| Program Address |
Rilutek Patient Assistance Program
C/O NORD
PO Box 1968
Danbury, CT 06813-1968 |
| Phone Number |
800-459-7599
203-744-0100
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| Fax Number |
203-798-2964 |
| Medications on Program |
Rilutek Tablets 50mg (riluzole)
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| Application Forms |
Not Applicable |
On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must have no prescription coverage or have reached his/her cap and meet income guidelines that are not disclosed. The patient must also have ALS. The patient must be a US citizen or legal resident.
The patient is given assistance for one year. A negative decision can be appealed.
The patient can be on Medicare and still apply for this program. Those with private insurance and a co-insurance of less than 80% can also apply.
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| Application Process |
The application can be downloaded, or the doctor or patient can call for a prescreening. The application is sent to the patient's home. The completed application must be mailed back.
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| Application Requirements |
The doctor needs to fill out a section, sign the application and attach an original prescription. The patient must fill out a section, sign the application and attach proof of income and any insurance information.
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| Program Details |
Up to a 90-day supply is sent to the patient's home. The company contacts the patient to arrange for refills. Once a year the application process must be repeated.
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| Last Updated |
June 02, 2010 |
