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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Forest Pharmaceuticals, Inc |
| Program Name |
Forest Pharmaceuticals Patient Assistance Program |
| Program Address |
13645 Shoreline Drive
Earth City, MO 63045-1241 |
| Phone Number |
800-851-0758
314-493-7000
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| Fax Number |
NA |
| Medications on Program |
Campral Tablets 333mg (acamprosate)
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| Application Forms |
Forest Pharmaceuticals 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 must meet insurance and financial guidelines that are not disclosed. meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The applicant must have a social security number It is important that the address on the prescription matches the mailing address on the application. If this is not the case, please attach letterhead to verify the delivery address.
Those with Medicare Part D may be eligible. Decisions are made on a case by case basis.
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| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application must be mailed back.
If the patient is denied, both patient and doctor are notified. Allow 4 weeks for processing and delivery of medication.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a 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. A new application is needed for each refill.
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| Last Updated |
September 09, 2009 |
