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

EstroGel Starter Units

For Healthcare Professionals Only

Provided by: ASCEND Therapeutics

Ascend Therapeutics
c/o SRF Processing,
607 Herndon Pkwy,
Herndon, VA 20170

TEL: 855-786-0738


ALT PHONE: 877-204-1013
FAX: 703-880-7484
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

EstroGel Sample Request Form for Healthcare Professionals Only

 

Brand Name Medications Covered

 
  • EstroGel gel
 

Generic Name

 
  • estradiol gel
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
   

Application

Obtaining Doctor/Doctor's office must call or download
Receiving Sent to Doctor's office
Returning Fax or mail from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not applicable
   

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

Resources for HEALTHCARE PROFESSIONALS ONLY

This company also provides copay assistance.


Updated July 07, 2017