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

Galderma Patient Assistance Program for Sculptra

This program provides brand name medications at no or low cost

Provided by: Galderma Laboratories, L.P. United States


TEL: Closed Program


Languages Spoken:

English

 

Patient Assistance Applications

 

Generic Name Medications Covered

 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

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

Medication

Amount/Supply Amount requested is sent
Sent To Doctor's office
Delivery Time Not specified
Refill Process Doctor/Doctor's office must contact the Program
Limit Contact the program for details
Re-application Enrollment is for 18 months
   

Additional Information


Updated October 05, 2018