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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Sanofi-Aventis |
| Program Name |
Sanofi-Aventis U.S. Patient Assistance Program |
| Program Address |
PO Box 759
Somerville, NJ 08876 |
| Phone Number |
800-221-4025
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| Fax Number |
866-734-7372 |
| Medications on Program |
Plaquenil Coated Tablets 200mg (hydroxychloroquine)
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| Application Forms |
Sanofi-Aventis Patient Assistance Program
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 250% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident. Patients with Medicare Part D are not eligible, however, if they have Part D and are still having problems affording the medication, they may apply. Sanofi Aventis may help patients in the donut hole. They will initially deny patient but submit an appeal and state that patient is in the DH and has no coverage.
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| Application Process |
With the patient's permission, anyone concerned can call for an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
Both the patient and health care professional are notified of acceptance into the program. The medication is shipped within 10 business days.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a brand name prescription. The patient must fill out a section and sign the application.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. Refills may be requested by calling an automated refill system. Faxed and phoned in refills are also available. Once a year a new application with financial documentation is needed.
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| Last Updated |
July 05, 2010 |
