Program

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Program 1 of 4 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Roche Pharmaceuticals
Program Name	Roche Patient Assistance Program for HCV, HIV, and Transplants
Program Address	PO Box 66763 St. Louis, MO 63166-6763
Phone Number	866-247-5084
Fax Number	800-305-1830
Medications on Program	Cellcept Capsules 250mg (mycophenolate mofetil) Cellcept Oral Solution 200mg/ml (mycophenolate mofetil) Cellcept Tablets 500mg (mycophenolate mofetil)
Application Forms	Not Applicable
On-line Application	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 meet insurance guidelines that are not disclosed and have an income at or below 300% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Each application is reviewed on a case by case basis, patients who are in need should contact the company.
Application Process	The patient or doctor needs to call for a prescreening. The application is sent to either the doctor or the patient. The completed application can be faxed back, but the originals must be mailed in as well. Both the patient and the health care professional are notified in writing of acceptance or denial. The decision is usually made within 48 hours.
Application Requirements	The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income.
Program Details	The medication is sent to either the doctor's office or the patient's home. The patient or doctor must contact the company for refills. Once a year the application process must be repeated.
Last Updated	April 05, 2010

Program 2 of 4 Scroll down to see them all.

This program provides generic medications at a discount.
Pharmaceutical Company	Xubex Pharmaceuticals
Program Name	Xubex Patient Assistance Program
Program Address	PO Box 1244 Winter Park, Fl 32790-1244
Phone Number	866-699-8239
Fax Number	407-671-7960
Medications on Program	mycophenolate mofetil Capsules 250mg (Cellcept)
Application Forms	Xubex Patient Assistance Program
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Applicants with insurance are eligible. This program does not have income limitations. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This is a program for generic medications only. There are fees for the medications:$20-$45 for a 90 day supply. ($40 or $60 for a 180 day supply and $80 or $120 for a 360 day supply.) Check the website for the exact price. A shipping and ordering fee of $3.85 is charged for each order. Patients may apply online or print the prescription, complete and fax to the Xubex pharmacy for processing. Requests may be expedited by having the physician fax the completed form to the Xubex pharmacy.
Application Process	Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back. The medication is shipped within 10 business days.
Application Requirements	The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Program Details	The medication is sent to either the doctor's office or the patient's home. The company automatically sends out refills. Once a year a new application with financial documentation is needed.
Last Updated	August 04, 2010

Program 3 of 4 Scroll down to see them all.

This company does not offer a patient assistance program.
Pharmaceutical Company	HealthWell Foundation
Program Name	HealthWell Foundation Copay Program
Program Address	P.O Box 4133 Gaithersburg, MD 20878
Phone Number	800-675-8416
Fax Number	800-282-7692
Medications on Program	Cellcept (mycophenolate mofetil)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Applicants with insurance are eligible. The Foundation considers an individual's financial, medical, and insurance situation when determining who is eligible for assistance. Families with incomes below 400% of the Federal Poverty Level may qualify. Cost of living in a particular city or state is also taken into account. Medication must be used for medically appropriate condition. The patient must also reside in the US. This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Application Process	Anyone can call to get the application sent out or it may be completed online. The application is sent out or it may be completed online.
Application Requirements	Not applicable.
Program Details	Not applicable.
Last Updated	April 28, 2010

Program 4 of 4.

This company does not offer a patient assistance program.
Pharmaceutical Company	Xubex Pharmaceuticals
Program Name	Xubex Copay Assistance Program
Program Address	PO Box 1244 Winter Park, Fl 32790-1244
Phone Number	866-699-8239
Fax Number	407-671-7960
Medications on Program	Cellcept Capsules 200mg, 250mg, 500mg (mycophenolate mofetil) Cellcept Tablets 200mg, 250mg, 500mg (mycophenolate mofetil)
Application Forms	Xubex Copay Program
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	This program does not have income limitations. Medical diagnosis is not necessary This program is not valid in Massachusetts, so MA residents are not eligible. This is a copay assistance program that covers all or part of the applicant's copay for the medication. The amount of the copay assistance varies by medication, check the program's website for the exact amount. The application does not require a HCP signature, however the applicant must send the prescription(s) in with the application.
Application Process	Anyone requesting assistance can call the above number to request an application be mailed or faxed out or download it from the website. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
Application Requirements	Not applicable.
Program Details	The medication is sent to the patient's home.
Last Updated	August 03, 2010