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Program 1 of 1.  Updated March 19, 2013 Back | Print Page

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

Salix Pharmaceuticals Patient Assistance Program

Provided by:


Salix Pharmaceuticals
PO Box 66520
St Louis MO 63166-6520

TEL: 866-282-6563


ALT PHONE:
FAX: 877-738-3694
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

  • Anusol-HC  Cream 2.5% (hydrocortisone)
  • Anusol-HC  Suppository 25mg (hydrocortisone)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must be citizen or legal resident
Obtaining Call
Receiving Sent to doctor or patient
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Within 2 weeks
Amount/Supply Up to 100 day supply
Sent To Patient's home
Delivery Time Within 2 weeks
Refill Process Refill/reorder form included with shipment
Limit None
Re-application New application yearly

Additional Information:

Must be at or below 400% FPL for Xifaxin.




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