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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Solvay Pharmaceuticals, Inc. |
| Program Name |
Solvay Pharmaceuticals Patient Assistance Program |
| Program Address |
C/O Express Scripts Speciality Distribution Svc.
PO Box 66550
St. Louis MO 63166-6550 |
| Phone Number |
800-256-8918
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| Fax Number |
800-276-9901 |
| Medications on Program |
Aceon Tablets 2mg, 4mg, 8mg (perindopril)
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| Application Forms |
Solvay Pharmaceuticals Patient Assistance 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 have no prescription insurance. meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. If a patient did not enroll in Medicare Part D, then s/he may still be eligible for this program and should apply. If a patient has Part D and has been denied coverage for Estrates, they may be considered by this program.
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| Application Process |
With the patient's permission, anyone concerned can call for an application. The application can be either faxed or mailed out upon request. The completed application must be faxed or mailed from the doctor's office.
The doctor or patient should call to check on status. The estimated timeline for acceptance is 7-10 business days. The medication is shipped within 2 business days.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.
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| Last Updated |
November 09, 2009 |
