Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
Galderma Patient Assistance Program for SculptraThis program provides brand name medications at no or low cost |
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Provided by: Galderma Laboratories, L.P. United States |
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TEL: Closed Program |
Languages Spoken:
English
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Patient Assistance Applications |
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Generic Name Medications |
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Eligibility Requirements |
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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 |
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Obtaining | Call or download | |||||
Receiving | Faxed or downloaded from website | |||||
Returning | ||||||
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 |
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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 |
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Updated October 05, 2018 |