Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Bayer Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Bayer HealthCare Pharmaceuticals Inc.

PO Box 29061
Phoenix, AZ 85038

TEL: 866-575-5002


ALT PHONE: 877-422-7709
FAX: 866-575-6568
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Bayer Patient Assistance Program Application

 

Medications

  • azelaic acid foam (Finacea Foam) Foam
  • azelaic acid gel (Finacea Gel) Gel
 

Eligibility Requirements   

Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call
Receiving Sent to doctor or patient
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Doctor notified via mailed letter
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office or patient's home
Delivery Time Within 7-10 business days
Refill Process Doctor/Doctor's office must complete replacement form
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

Eligibility determined on a case-by-case basis.


Updated March 23, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation

PO Box 220410
Chantilly, VA 20153-0410

TEL: 800-675-8416


FAX: 800-282-7692
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program: Contact program

 

Medications

  • azelaic acid (Azelex) 
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months
   

Additional Information

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.
Updated May 22, 2017