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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Merck & Company , Inc. |
| Program Name |
ACT Program |
| Program Address |
ACT Program
PO Box 18979
Louisville, KY 40261-0979 |
| Phone Number |
866-363-6379, opt 1
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| Fax Number |
866-363-6389 |
| Medications on Program |
Emend for Injection (aprepitant)
Emend tri-pack (aprepitant)
Intron-A Recombinant for Injection (interferon alpha 2b)
Noxafil Oral Suspension (posaconazole)
Peg-Intron (peginterferon alfa 2b)
REBETOL Capsules (ribavirin)
Temodar Capsules 5mg, 20mg, 100mg, 250mg (temozolomide)
TICE BCG (bcg live)
Zolinza Capsules 100mg (vorinostat)
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| Application Forms |
ACT Program
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On-line Application
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| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must be uninsured or underinsured and have an income at or below 500% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be under treatment from a US doctor. Patients in need who appear not to qualify should still call. Spanish speaking interpreter is available.
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| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
Both the patient and health care professional are notified of acceptance into the program. The decision is usually made within 72 hours. The medication is shipped within 2 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 and sign the application.
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| Program Details |
The medication is sent to either the doctor's office or the patient's home. The patient must contact the company to arrange for refills. Once a year the application process must be repeated.
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| Last Updated |
June 03, 2010 |
