Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated July 23, 2014

Radiesse Patient Access Program

This program provides brand name medications at no or low cost.

Provided by: BioForm Medical

RADIESSE Patient Access Program
4133 Courtney Rd
Suite 10
Franksville, WI 53126

TEL: 866-862-1211


ALT PHONE:
FAX: 966-862-1212
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

 

Generic Medications

 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Not specified
Income Family income at or below $80,000
Diagnosis/Medical Criteria Facial lipoatrophy associated with HIV and be at least 18 years old
US Residency Required? Must be citizen
   

Application

Obtaining Doctor/Doctor's office must call
Receiving Faxed, mailed or downloaded from website
Returning 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
Decision Timeframe 5-7 business days
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 2 weeks of receiving application
Refill Process Doctor/Doctor's office must contact company
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

Patient Assistance Program questions are provided by Merz Aesthetics.