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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Roche Pharmaceuticals |
| Program Name |
Boniva Patient Assistance Program |
| Program Address |
P.O. Box 29064
Phoenix, AZ
85038 |
| Phone Number |
888-587-9438
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| Fax Number |
N/A |
| Medications on Program |
Boniva IV 3mg (ibandronate)
Boniva Tablets 150mg (ibandronate)
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| Application Forms |
Not Applicable |
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 have no prescription coverage, have reached his/her cap or cannot afford the co-payments and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident or legal alien. Patients who are eligible for Medicare Part D but did not enroll may still be eligible for this program. Patients who are in the Medicare Part D, Donut Hole and can not afford the medication may also still be eligible for this program.
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| Application Process |
The patient or doctor needs to call for a prescreening. The application is sent to either the doctor or the patient. The completed application can be faxed or mailed back.
Both the patient and health care professional are notified of acceptance into the program. The estimated timeline is 2-4 business days. The medication is shipped within 3-5 business days.
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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, sign the application and attach proof of income and any insurance information.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office or the patient's home. The company contacts the doctor to arrange for refills. Once a year a new application with financial documentation is needed.
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| Last Updated |
July 21, 2010 |
