| 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 Covered |
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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 | ||||||
