Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 1 of 2   Scroll down to see them all.  Updated January 03, 2013 Back | Print Page

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

Merck Patient Assistance Program

Provided by:


Merck & Company, Inc.
PO Box 690
Horsham, PA 19044-9979

TEL: 800-727-5400


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

Cosopt Ophthalmic Solution 5ml, 10ml (dorzolamide/timolol)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes
Income At or below 400% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign
Decision Communicated Call for decision
Decision Timeframe Up to 10 business days
Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient requests refills via a toll-free number
Limit Not specified
Re-application New application yearly

Additional Information:

At Merck we realize that sometimes exceptions need to be made based on the patient's individual circumstances. if you do not meet the prescription drug coverage criteria, your income meets the program criteria, and there are special circumstances of financial and medical hardship that apply to your situation, you can request that an exception be made for you.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 2.  Updated November 05, 2012 Back | Print Page

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

Alcon Cares

Provided by:


ALCON
Alcon Cares, Inc.
TB3-4
6201 South Freeway
Fort Worth, TX 76134-0450

TEL: 800-222-8103


ALT PHONE:
FAX: 800-554-2660
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Cosopt Ophthalmic Solution  (dorzolamide/timolol)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be treated by US Doctor
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete, sign, attach proof of income
Decision Communicated Patient notified of denial in writing
Decision Timeframe Within 24-48 hours
Amount/Supply Up to 6 months supply
Sent To Doctor's office
Delivery Time Within 3 weeks of receiving application
Refill Process Copy of application with new dates
Limit Not specified
Re-application New application yearly

Additional Information:

Those over the 250% FPL guidelines may have their medical expenses taken into consideration. OTC products may be sent to either the patient's home or the doctor's office.

Some medications are available only as generic and some are available only as brand name. CONTACT THE PROGRAM FOR DETAILS.



Read our privacy policy.

Copyright ©2013 by NeedyMeds, Inc.
Contents may not be reproduced in any form
except for personal use
and may not be used on any other website without permission.

NeedyMeds makes every effort to ensure the accuracy of the information on the website.
However, we can't guarantee the accuracy or completeness of the information.
Always check with the individual program if you have questions.