|
This program provides brand name medications at no or low cost.
|
| Pharmaceutical Company |
Galderma Laboratories |
| Program Name |
Galderma Laboratories Patient Assistance Program |
| Program Address |
122 S. Michigan Ave.
Suite 1100
Chicago, IL 60603 |
| Phone Number |
866-730-5074
|
| Fax Number |
312-935-3599 |
| Medications on Program |
Vectical Ointment 3mcg/g (calcitriol)
|
| Application Forms |
Galderma Laboratories 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 |
The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 200% 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 who are eligible but did not enroll in Medicare Part D may still be eligible for this program. Differin Gel 0.3% is on the program, but not on the application.
|
| Application Process |
Anyone can write the company to request an application. The application will be faxed out. The completed application can be faxed or mailed back.
The patient is notified of eligibility for the program. The estimated timeline for acceptance is 7-10 business days.
|
| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
|
| Program Details |
The patient is sent a pharmacy card. A copy of the same application with new dates is needed for refills. Once a year the application process must be repeated.
|
| Last Updated |
May 10, 2010 |
