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

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Bayer US Patient Assistance Foundation Free Drug Program

This program provides brand name medications at no or low cost

Provided by: Bayer US Patient Assistance Foundation

PO Box 5670
Louisville, KY 40255

TEL: 866-228-7723


FAX: 866-575-6568
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Bayer US Patient Assistance Foundation Free Drug Program Application

Bayer US Patient Assistance Foundation Free Drug Program Application (Spanish)

 

Medications

  • Angeliq (drospirenone/estradiol)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be residing in the US or Puerto Rico
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Not specified
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 October 11, 2018