| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Mirena |
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Bayer US Patient Assistance Foundation Free Drug ProgramThis program provides brand name medications at no or low cost |
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Provided by: Bayer US Patient Assistance Foundation |
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PO Box 5670 TEL: 866-228-7723FAX: 866-575-6568 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Bayer US Patient Assistance Foundation Free Drug Program Application |
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Bayer US Patient Assistance Foundation Free Drug Program Application (Spanish) |
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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 | Medically appropriate condition/diagnosis | ||
| US Residency Required? | Must be residing in the US or Puerto Rico | ||
Application |
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| 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 |
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| Amount/Supply | Varies | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Doctor/Doctor's office must contact the Program | ||
| Limit | Not specified | ||
| Re-application | New application, new documentation yearly | ||
Additional Information |
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| Eligibility determined on a case-by-case basis. |
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| Updated September 21, 2023 | |||
