All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- From: the Special Committee On Aging United States Senate Senator William S. Cohen, Chairperson April, 1995 Dear Friend, Many Americans find it difficult to afford prescription drugs. For older Americans the problem is particularly severe. Some pharmaceutical manufacturers have established programs to make some of their drugs available free of charge to needy patients. This publication lists and explains these special programs commonly referred to as "indigent patient drug programs." Read the following information carefully, and then talk to your doctor if you think you may qualify for such a program. Please be aware that these are NOT government sponsored programs. Sincerely, William S. Cohen, David Pryor ========================================================= How can I use this information to get medication that has been prescribed to myself or a family member? Find the name of the manufacturer who makes the prescribed drug in the list below. Read the information about the company's program. If you think you may qualify for one of these programs, talk to your doctor about it. Most programs require that your doctor contact the manufacturer. How do I know if I am eligible for a program? Each company determines who qualifies for their program. Many programs simply require the doctor to say that the patient cannot afford the prescribed drugs. Other programs require a patient to meet certain income or assets measures. Private health insurance, third-party coverage, Medicaid, or Medicare may disqualify you from such a program. What if the drug I need is not listed here? Not all drugs are available through these programs. However, new programs and new drugs are continually being developed. Contact the manufacturer directly for more information about other programs that may be available. What if my doctor will not enroll me in an assistance program? Since these are not government funded programs, some doctors may not participate in them. In this case, consult with another doctor or check if the program you want to be in has a special patient number you can use to enroll yourself. ========================================================= List of Pharmaceutical Manufacturers Indigent Patient Programs ADRIA LABORATORIES, INC. Adria Laboratories Patient Assistance Program PO Box 9525 McLean, VA 22102 1-800-366-5570 Doctor must certify that patient cannot afford the cost of the drug. ALLERGAN PRESCRIPTION PHARMACEUTICALS Allergan Patient Assistance Program 2525 Dupont Drive Irvine, CA 92713 1-800-347-4500 Ext. 4280 Up to a 6 months' supply. Eligibility is at the doctor's discretion. AMGEN, INC. Amgen Safety Net Programs Medical Technology Hotlines: 1-800-272-9376 Enrollment in the program is based on a patient's insurance and financial status. ASTRA F.A.I.R. FOSCAVIR Assistance and Information on Reimbursement Program: 1-800-488-3247. Doctor must sign and complete the application and return it within 7 days to the address on the form. The form must be accompanied by a signed prescription. BOEHRINGER INGLEHEIM PHARMACEUTICALS, INC. PARTNERS IN HEALTH 1-800-556-8317 Controlled substances are not covered. Maximum of 3 months. Patient cannot have prescription coverage, cannot be eligible for Medicaid/State assistance programs, and must meet annual income guidelines. Doctor must make the request. BRISTOL-MYERS SQUIBB Bristol-Myers Squibb Patient Assistance Program PO Box 9445 McLean, VA 22102-9998 1-800-736--0003 At doctor's request. BRISTOL-MYERS SQUIBB Cancer Patient Access Program Bristol-Myers Squibb Cancer Patient Access Program 2400 West Lloyd Expressway Evansville, IN 47721, Mail Code R-22 1-800-437-0994. Two months' supply. Financial screening on case by case basis. BURROUGHS-WELLCOME Patient Assistance Program Burroughs-Wellcome Co. PO Box 52035 Phoenix, AZ 85072-9349 1-800-722-9294 Products available in a 30 day supply, with maximum of 90 days. Applications reviewed on a case by case basis. Patients must be residents of the United States or its territories. All alternative funding sources must be investigated. CIBA-GEIGY PHARMACEUTICAL Patient Support Program Jackie LaGuardia, Senior Information Assistant Ciba-Geigy Corporation 556 Morris Ave. D2058 Summit, NJ 07901 1-800-257-3273. Up to 3 months' supply available. DU PONT MERCK PHARMACEUTICAL CO. Darlene Samis Du Pont Pharma PO Box 80026 Wilmington, DE. 19880-0026 1-800-474-2762 Controlled substances are not covered. Thirty day supply available. Patient must be indigent and ineligible for a Federal or State Government drug assistance program. GENENTECH, INC. Genentech, Inc. PO Box 2586 S. San Francisco, CA 94083-2586 1-800-879-4747 Quantity provided. Eligibility requirements variable. GLAXO, INC. Laura N. Wright, Supervisor, Glaxo Indigent Patient Program Glaxo, Inc. PO Box 13438 Research Triangle Park, NC 27709 1-800-452-9677 Maximum 3 month supply. Patient must be a private outpatient whom the doctor considers medically indigent and who is not eligible for other third-party reimbursement. HOECHST-ROUSSEL PHARMACEUTICALS, INC. HRPI Patient Access Program Field Forest Development 1-800-422-4779 Must show lack of insurance or ability to pay. Eligibility on a case by case basis. Patients must not be eligible for a third-party payer or Medicaid coverage. One course of therapy. HOFFMAN-LaROCHE, INC. Daria Osborne, Director, Medical Needs Program Roche Laboratories 340 Kingsland Street Nutley, NJ 07110 1-800-285-4489 Three month supply. Eligibility limited to private practice outpatients who are considered by the doctor to be medically indigent and who are not eligible for other third-party reimbursement. Drugs are shipped to doctor only. IMMUNEX CORPORATION Professional Services Immunex Corporation 1-800-466-8639 ; 206-587-0430 Three cycles. Physician must state that the patient requires the drug and that all reimbursement options have been tried. JANSSEN PHARMACEUTICA Janssen Patient Assistance Program 1800 Robert Fulton Drive Reston, VA 22091 1-800-544-2987 One or two month supply, varies by product. Patient must have less than $25,000 total annual household income and can have Medicare or private insurance, but cannot have prescription coverage. KNOLL PHARMACEUTICAL CO. Knoll Pharmaceutical Indigent Patient Program 30 N. Jefferson Road Whippany, NJ 07981 1-800-524-2474 Eligible if financially indigent and not insured. LEDERLE LABORATORIES Lederle Partners and Patient Care 1-800-533-2273 Doctor must make the request. Patients have to be financially indigent and not eligible for coverage under third-party insurance or Medicaid. ELI LILLY AND COMPANY Lilly Cares Patient Assistance Program PO Box 9105 McLean, VA 22102-0105 1-800-545-6962 Does not cover controlled substances. Quantities depend on the product and the doctor's instructions. Eligibility determined on case by case basis. Doctors must submit a written request containing specific information. MARION MERRELL DOW, INC. Indigent Patient Program PO Box 8600 Kansas City, MO 64114 1-800-362-7466 Three month supply. Doctor determines if patient is eligible for the program. Eligibility also based on income level and lack of insurance. McNEIL PHARMACEUTICAL Thomas Schwend, Manager, Medical Information McNeil Pharmaceutical Corporation PO Box 300 Route 202 South Raritan, NJ 08869-0602 1-800-682-6532 Varies by product and patient condition. Doctor determines that patient is indigent and not eligible for health insurance. Doctors may request free medications by written or telephone request, accompanied by a signed and dated prescription and letter stating financial status and need of patient. MERCK & COMPANY, INC. Patient Assistance Program Merck & Co., Inc. PO Box 4-WP35-258 West Point, PA 19486-0004 215-652-5000 (collect calls accepted) Only doctors can call and request applications. MILES PHARMACEUTICALS Miles Indigent Patient Program 400 Morgan Ave. West Haven, Connecticut 06516 1-800-998-9180 Quantities and length of support determined on case by case basis. Doctor must certify that patient is not eligible for or covered by government funded reimbursement or insurance drug programs. Patient income must be below federal poverty guidelines. ORTHO BIOTECH INC. Ortho Biotech Financial Assistance Program 1800 Robert Fulton Drive Reston, VA 22091-4345 1-800-553-3851 1) Financial Assistance Program (FAP)1-800-447-3437 provides PROCRIT therapy free to any qualifying nondialysis patient who cannot obtain insurance coverage, is uninsured or cannot afford cost of their treatment. 2) Cost Sharing Program 1-800-441-1366 limits the annual cost of PROCRIT expenditures for a patient exceeding $8,500 for a calendar year, regardless of third-party coverage. 3) LEUSTATIN Financial Assistance Program 1-800-447-3437 provides LEUSTATIN therapy free to persons who meet specific criteria and lack financial resources and third-party insurance necessary to obtain treatment. ORTHO PHARMACEUTICALS Thomas Schwend, Manager, Medical Information Ortho Pharmaceutical Corporation PO Box 300 Route 202 South Raritan, NJ 08869-0602 1-800-682-6532 Varies by product and patient condition. Doctor determines that patient is indigent and not eligible for health insurance. Doctor may request free drugs by written or telephone request, accompanied by a signed and dated prescription and letter stating financial status and need of patient. PARKE-DAVIS Parke-Davis Patient Assistance Program PO Box 9945 McLean, VA 22102 1-800-755-0120 Applications taken over the phone. To apply, patient or doctor calls Parke-Davis with the following information: Doctor's full name, address, phone number - and - Patient's name, address, phone number and financial status. PFIZER, INC. PROGRAM #1 Pfizer Indigent Patient Program PO Box 25457 Alexandria, VA 22314-5457 1-800-646-4455 Up to 3 month supply at one time, as prescribed. Any patient that a doctor is treating as indigent is eligible. Patient must not be covered by third-party insurance or Medicaid. Usually takes 3 to 4 weeks to get medication. Refills are available upon request by doctor. PFIZER, INC. PROGRAM #2: ROERIG DIVISION Diflucan Patient Assistance Program 1-800-869-9979 Up to three months' supply at one time and then can reapply. Patient must not have insurance or other third-party coverage, including Medicaid. Patient must not be eligible for a state AIDS drug assistance program. Patient must have income less than $25,000 a year without dependents; or less than $40,000 a year with dependents. PROCTER & GAMBLE PHARMACEUTICALS, INC. Procter & Gamble Pharmaceuticals, Inc. 17 Eaton Avenue Norwich, NY 13815 1-800-448-4878 Quantity varies depending upon the situation, but at least a one month supply can be obtained upon receipt of a doctor's prescription. The company relies on doctor's appraisal of patient need. The company also helps patient identify other sources of financial help to pay for medications. R&D LABORATORIES Patient Support Program R&D Laboratories, Inc. 4094 Glencoe Avenue Marina del Rey, CA 90292 1-800-338-9066 Every R&D Laboratories pharmaceutical nutritional supplement has a special Indigent Patient Program sticker. Patients bring the stickers from their bottles of R&D products with them when they come to the dialysis unit. Stickers are attached to the back of a booklet supplied by the company and the completed booklet is returned to R&D Laboratories. For every 12 stickers we receive from a unit, R&D sends nutritional product of facility's choice for free distribution to indigent patients. SANDOZ PHARMACEUTICALS Sandoz/NORD Drug Cost Share Program PO Box 8923 New Fairfield, CT 06812 1-800-447-6673 The National Organization for Rare Disorders (NORD)/Sandoz Drug Cost Share Program (DCSP) is solely administered by NORD. Sandimmune, Sandostatin, Parlodel, Lescol, DynaCirc and Eldepryl are covered under one program. Clozaril is covered under a different program. Patient is awarded up to one year's supply of drug, which is shipped in 3 month supplies via the mail-order pharmacy used by the program. Clozaril-Patient is eligible to receive up to one year's supply of the drug, dispensed only one week at a time. NORD determines eligibility by medical and financial criteria. The patient/applicant must show financial need above and beyond the availability of Federal and State funds, private insurance or family resources. SANOFI WINTHROP PHARMACEUTICALS Sanofi Winthrop Pharmaceutical Needy Patient Program Product Information Department 90 Park Avenue New York, NY 10016 212-907-2000; 1-800-446-6267 (Push #1 twice when automated answering machine picks up) One unit or one month's supply, as required. Subject to acceptance by the company, patients can obtain medications by having their doctor request the product or provide a written order for the product, and confirm the patient's need. SCHERING-PLOUGH For Intron/Eulexin Products: Service Program, Schering Laboratories 2000 Galloping Hill Road Building K-5-2B2 Kenilworth, NJ 07033 Initial supply is for 3 months. Renewals available for 3 months at a time. Eulexin-Initial supply is for 6 months. Renewals available for 6 months at a time. For other Schering Products: Drug Information Services Indigent Program 1-800-521-7157 Initial 3 month supply, with renewals available for up to 3 months at a time. Eligibility determined on case by case basis. The consultation includes a review of the specific case as well as the availability of other means of health care assistance. SEARLE Patients in Need Foundation 5200 Old Orchard Road Skokie, IL 60077 1-800-542-2526 Supply based on the doctor's of patient needs. The program is conducted through the doctor, who determines the patient's eligibility based on medical and economic need. Searle provides suggested guidelines to the doctor. SMITHKLINE BEECHAM: PROGRAM #1 SB Access to Care Program SmithKline Beecham Pharmaceuticals One Franklin Plaza-FP1320 Philadelphia, PA 19101 1-800-546-0420 (patient requests) 215-751-5722 (doctor requests) Doctor determines which patients are eligible and would benefit from the Access to Care Program. Doctors must submit forms to enroll patients in the program. Three month supply is available at one time. Requests must come from the doctor. Patient's prescription qualifies only if it is not already covered under private insurance. SMITHKLINE BEECHAM: PROGRAM #2 Eminase/Kytril/Triostat Compassionate Care Programs SmithKline Beecham Pharmaceuticals One Franklin Plaza-FP1320 Philadelphia, PA 19101 1-800-866-6273 Patient must show ineligibility for other forms of medical assistance and meet the program's income requirements (single patients with annual incomes of $18,000 or less, and persons who are married or have at least one dependent with annual income of $25,000 or less). For each eligible patient, hospitals should submit a Hospital Consent Form and an Application Form with any one of the following documents: a copy of the patient's medical record, pharmacy record, or the patient's bill. SYNTEX LABORATORIES, INC. Cytovene Medical Information Line 1-800-444-4200 General telephone number to inquire about indigent patient programs is 1-800-822-8255. Up to 25 vials of Cytovene are available. Syntex provides Cytovene free of charge when it is prescribed for an immuno-compromised patient who has been diagnosed as having CMV (cytomegalovirus) retinitis, if that patient lacks the means to purchase the drug, and that patient is ineligible for any form of third-party reimbursement. For information on other Syntex products call 1-800-822-8255. THE UPJOHN COMPANY Patient Assistance Program Upjohn Company 1-800-242-7014 Health Care Professionals should contact their local Upjohn Representative. Generally, a 3 month supply is provided. However, a doctor can request a longer supply. Doctor determines patient's needs, and whether insurance or other social programs to help provide medications are available. WYETH-AYERST LABORATORIES John E. James Wyeth-Ayerst Laboratories Indigent Patient Program 555 East Lancaster Avenue St. Davids, PA 19087 1-800-568-9938 In general, 1 to 2 month supply is provided. For Cordarone, one month supply or up to 2 bottles of 60 tablets is provided. Patient must be medically indigent, with no coverage for drugs. ZENECA PHARMACEUTICALS Yvonne A. Graham, Program Director Zeneca Pharmaceuticals Group PO Box 15197 Wilmington, DE 19850-5197 1-800-424-3727 One to 3 month supply with application. ============================================================= This section identifies the name of medications through 1995 often prescribed for older Americans, and the drug's maker. If a drug that you take is NOT listed here, it may still be provided under such a progrma. Have your doctor call the company to find out. DRUG - MANUFACTURER A Aci-Jel - Ortho Actigall - Ciba-Geigy Actimmune - Genentech Activase - Genentech Adriamycina PFS - Adria Adrucil - Adria Aldactone - Searle Aldomet - Merck ALT/S - Hoechst-Roussel Altace - Hoechst-Roussel Alupent - Boehringer Anafranil - Ciba-Geigy Anaprox - Syntex Ansaid - Upjohn Antivert - Pfizer #1 Anturane - Ciba-Geigy Anusol HC - Parke-Davis Apresazide - Ciba-Geigy Apresoline - Ciba-Geigy Aralen - Sanofi Winthrop Aredia - Ciba-Geigy Artane - Lederle Asacol - Procter & Gamble Atrovent - Boehringer Augmentin - SmithKline Axid - Eli Lilly AZT (Retrovir) - Burroughs-Wellcome B Bactrim DS - Hoffman-LaRoche Bactroban - SmithKline Beconase - Glaxo Beconase AQ - Glaxo Betagan - Allergan BICNU - Bristol-Myers #3 Blenoxance - Bristol-Myers #3 Bleph-10 - Allergan Breonesin - Sanofi Winthrop Brethaire - Ciba-Geigy Bronkometer - Sanofi Winthrop BuSpar - Bristol-Myers #1 C Calan - Searle Calan SR - Searle Capoten - Bristol-Myers #2 Capozide - Bristol-Myers #2 Carafate - Marion Merrell Dow Cardene - Syntex Cardizem - Marion Merrell Dow Cardura - Pfizer #1 Carnitor - Sigma-Tau Cataflam - Ciba-Geigy Catapres - Boehringer Ceclor - Eli Lilly CEENU - Bristol-Myers #3 Ceftin - Glaxo Cefzil - Bristol-Myers #1 Cipro - Miles Claforan - Hoechst-Roussel Clinoril - Merck Clozaril - Sandoz Cogentin - Merck Compazine - SmithKline Cordarone - Wyeth-Ayerst Corgard - Bristol-Myers #2 Corzide - Bristol-Myers #2 Coumadin - DuPont Merck Cyclospasmol - Wyeth-Ayerst Cytadren - Ciba-Geigy Cytotec - Searle Cytovene - Syntex Cytoxan - Bristol-Myers #3 D Dalmane - Hoffman-LaRoche Danocrine - Sanofi Winthrop Dantrium - Procter & Gamble Desferal - Ciba-Geigy Desyrel - Bristol-Myers #1 Diabeta - Hoechst-Roussel Diabinese - Pfizer #1 Diamox - Lederle Didronel - Procter & Gamble Dienestrol - Ortho Diflucan - Pfizer #2 Dilantin - Parke-Davis Diprolene - Schering-Plough Diprosone - Schering-Plough Dolobid - Merck Drisdol - Sanofi Winthrop Duricef - Bristol-Myers #1 Dyazide - SmithKline #1 Dymelor - Eli Lilly DynaCirc - Sandoz E E-Mycin - Upjohn Efudex(Fluorouracil Inj) - Hoffman Eldepryl - Sandoz Eminase - SmithKline #2 Epifrin - Allergan Epogen - Amgen Ergamisol - Janssen Erycette - Ortho Esidrix - Ciba-Geigy Esimil - Ciba-Geigy Estrace - Bristol-Myers #1 Eulexin - Schering-Plough Extel - Procter & Gamble F Feldene - Pfizer #1 Flexeril - Merck Floxin - Ortho FML - Allergan Foscavir - Astra Fulvicin - Schering-Plough G Glucotrol - Pfizer #1 H Habitrol - Ciba-Geigy Halcion - Upjohn Haldol - McNeil Hismanal - Janssen Hivid - Hoffman-LaRoche HMS - Allergan Hytakerol - Sanofi Winthrop I Idamycin - Adria Ifex - Bristol-Myers #3 Imodium - Janssen Imuran - Burroughs-Wellcome Indocin - Merck Insulin Humulin and Ilentin - Eli Lilly Interferon-A Recomb - Hoffman Intron-A - Schering-Plough Ismelin - Ciba-Geigy Isoptin - Knoll Isordil - Wyeth-Ayerst Isuprel - Sanofi Winthrop K K-Lyte - Bristol-Myers #1 Keflex - Eli Lilly Kerlone - Searle Klonopin - Hoffman-LaRoche Klotrix - Bristol-Myers #2 L Lamprene - Ciba-Geigy Lanoxin/Burroughs-Wellcome Lasix - Hoechst-Roussel Lescol - Sandoz Leucovorin Calcium - Lederle Leukine - Immunex Librium - Hoffman-LaRoche Limbritol - Hoffman-LaRoche Lioresal - Ciba-Geigy Lithobid - Ciba-Geigy Lo/Ovral - Wyeth-Ayerst Lodosyn - DuPont-Merck Lopid - Parke-Davis Lopressor - Ciba-Geigy Loprox - Hoechst-Roussel Lotensin - Ciba-Geigy Lotrimin - Schering-Plough Lotrisone - Schering-Plough Loxapine - Lederle Ludiomil - Ciba-Geigy Lyophilized Cytoxan - Bristol-Myers #3 M Macrobid - Procter & Gamble Macrodantin - Procter & Gamble Maxzide - Lederle Medrol - Upjohn Megace - Bristol-Myers #3 Mepron - Burroughs-Wellcome Mesnex - Bristol-Myers #3 Mevacor - Merck Micronase - Upjohn Minipress - Pfizer #1 Minocin - Lederle Monistat - Ortho Monistat-Derm - Ortho Monopril - Bristol-Myers #2 Motrin - Upjohn Myambutol - Lederle Mycostatin - Bristol-Myers #1 Mytelase - Sanofi Winthrop N Naprosyn - Syntex Nasalide - Syntex Natalins RX - Bristol-Myers #1 NegGram - Sanofi Winthrop Neosar - Adria Neupogen - Amgen Neurontin - Parke-Davis Nicorette - Marion Merrell Dow Nimotop - Miles Nizoral - Janssen Nolvadex - Zeneca Nordette - Wyeth-Ayerst Normodyne - Schering-Plough Noroxin - Merck Norpace - Searle Norplant System - Wyeth-Ayerst Nutropin - Genentech O Oculinium - Allergan Optimine - Schering-Plough Orinase - Upjohn Orudis - Wyeth-Ayerst Ovcon - Bristol-Myers #1 P Pancrease - McNeil Parafon Forte DSC - McNeil Paraplatin - Bristol-Myers #3 Parlodel - Sandoz Pavabid - Marion Merrell Dow PBZ - Ciba-Geigy Pepcid - Merck Periactin - Merck Persa-Gel - Ortho Persantine - Boehringer Phisohex - Sanofi Winthrop Pilogan - Allergan Plaquenil - Sanofi Winthrop Platinol - Bristol-Myers #3 Plendil - Merck Ponstel - Parke-Davis Pravochol - Bristol-Myers #2 Premarin - Wyeth-Ayerst Prilosec - Merck Primaquine - Sanofi Winthrop Prinivil - Merck Procan - Parke-Davis Procardia - Pfizer #1 Procrit - Ortho Biotechnology Prokine - Hoechst-Roussel Pronestyl SR - Bristol-Myers #2 Propine - Allergan Propulsid - Janssen Proscar - Merck Prostat - Ortho Protropin - Genentech Proventil - Schering-Plough Provera - Upjohn Prozac - Eli Lilly Pyridium - Parke-Davis Q Questran - Bristol-Myers #2 Quinamm - Marion Merrell Dow R Regitine - Ciba-Geigy Relafen - SmithKline Rheumatrex - Lederle Rimactane - Ciba-Geigy Risperdal - Janssen #1 Rocaltrol - Hoffman-LaRoche Rocephin - Hoffman-LaRoche Rythmol - Knoll S Sandimmune - Sandoz Sandoglobulin - Sandoz Sandostatin - Sandoz Santyl - Knoll Sectral - Wyeth-Ayerst Septra DS - Burroughs-Wellcome Seldane - Marion Merrell Dow Sinemet - DuPont-Merck Sorbitrate - Zeneca Spectazole - Ortho Sporanox - Janssen Sultrin - Ortho Symmetrel - DuPont Merck Synalar - Syntex Synemol - Syntex T Tagamet - SmithKline Tarabine - Adria Tenormin - Zeneca Terazol - Ortho Timolol - Merck Timoptic - Merck Tofranil - Ciba-Geigy Tolectin - McNeil Topicort - Hoechst-Roussel Trancopal - Sanofi Winthrop Trandate - Glaxo Trental - Hoechst-Roussel Trexan - DuPont-Merck Tridesilon Cream - Miles Triostat - SmithKline #2 Triphasil - Wyeth-Ayerst V Vagistat - Bristol-Myers #l Valium - Hoffman-LaRoche Vascor - McNeil Vasodilan - Bristol-Myers #3 Vasoretic - Merck Vasotec - Merck VePesid - Bristol-Myers Verelan - Lederle Vermox - Janssen Vincasar - Adria Voltaren - Ciba-Geigy W Wellcovorin - Burroughs-Wellcome Wytensin - Wyeth-Ayerst X Xanax - Upjohn Z Zantac - Glaxo Zestoretic - Zeneca Zestril - Zeneca Zoloft - Pfizer #1 Zovirax - Burroughs-Wellcome Zyloprim - Burroughs-Wellcome