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

Mission Product Request

For Healthcare Professionals Only

Provided by: Mission Pharmacal Company


TEL: 877-425-0325


ALT PHONE: 800-531-3333
FAX: 877-426-2795
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Mission Product Request: Contact program

 

Medications

  • artificial saliva spray (Aquoral) Spray
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not disclosed
US Residency Required? Not specified
   

Application

Obtaining The Doctor should call for an application or download it from the website
Receiving Faxed to Doctor's office
Returning Fax from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Doctor contacts company
   

Additional Information

Resources for HEALTHCARE PROFESSIONAL ONLY.
The Doctor must contact the program to place an order.


Updated September 21, 2017