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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Actelion Pharmaceuticals |
| Program Name |
Tracleer Access Program |
| Program Address |
PO Box 826
South San Francisco, CA 94083-0826 |
| Phone Number |
866-228-3546, opt 1
|
| Fax Number |
866-279-0669 |
| Medications on Program |
Tracleer Tablets 62.5mg, 125mg (bosentan)
|
| Application Forms |
Tracleer Access Program
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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 be uninsured or rendered underinsured by payor denial and
meet income guidelines that are not disclosed. The patient must also be taking the medication for an on-label diagnosis. The patient must be a US citizen or legal resident. This program has two steps: the first is to fill out the patient enrollment form and send it to the Tracleer Access Program. The enrollment form is downloadable from the website or it can be requested by calling the Tracleer Access Program. If the patient has no coverage for the medication, then the information is forwarded to the counselor at the Tracleer Patient Assistance Program to be screened for eligibility. An application will be sent to the patient for more information and proof of income after the initial phone screen.
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| Application Process |
Not applicable.
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| Application Requirements |
Not applicable.
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| Program Details |
Up to a 30-day supply is sent to the doctor's office or the patient's home. The company contacts the patient to arrange for refills. Every year a new application is needed.
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| Last Updated |
November 10, 2009 |
