Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated September 15, 2014
 

Osphena

Osphena Savings Program

This is a discount card program.

Provided by: Shionogi Inc.

Osphena Claims Processing Dept
PO Box 7017
Bedminster, NJ 07921-7017

TEL: 855-285-8108


ALT PHONE: 855-677-4362
FAX:
Languages Spoken:

English, French, Spanish

Program Website

 

Patient Assistance Applications

 Osphena Savings Program: Contact program

 

Medications

  • Osphena Tablet 60mg (ospemifene)
 

Eligibility Requirements   

Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income Not Required
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Enroll online
Receiving Not applicable
Returning Not applicable
Doctor's Action Give prescription to patient
Applicant's Action Complete online enrollment
Decision Communicated Not applicable
Decision Timeframe Not applicable
   

Medication

Amount/Supply 90 day supply
Sent To Patient is sent savings card to be used at pharmacy
Delivery Time Not applicable
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit 6 uses
Re-application Not applicable
   

Additional Information

Eligible patients pay a minimum of $35 and receive up to $50 off co-pay or out-of-pocket expenses (per 30-day supply) on the next 6 prescriptions. Patients are responsible for additional costs over the maximum $50 savings.

This program expires December 31, 2015.

This program also provides reimbursement assistance.