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Program 1 of 1.  Updated January 02, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

Forest Pharmaceuticals Patient Assistance Program

Provided by:


Forest Pharmaceuticals, Inc.
13645 Shoreline Drive
Earth City, MO 63045-1241

TEL: 800-851-0758


ALT PHONE:
FAX:
Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Aerochamber Plus w/ Mask Flow-Vu Inhaler  (inhaler spacer)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Must've been denied LIS. Mustn't be eligible for Medicaid
Income Not disclosed
Diagnosis/Medical Criteria Not required
US Residency Required? Must have a social security number
Obtaining Call or download
Receiving Faxed or mailed
Returning Mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach insurance information
Decision Communicated If denied, patient and Doctor notified
Decision Timeframe 2-4 weeks
Amount/Supply Up to 3 months supply
Sent To Doctor's office or pharmacy
Delivery Time Within 4 weeks
Refill Process New application and new prescription
Limit None
Re-application New application needed for each refill

Additional Information:

The address on the prescription should match the mailing address on the application. If this is not the case, please attach letterhead to verify the delivery address. Eligibility determined on a case-by-case basis.



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