ofprescription drug patient assistance...

1999–2000

Directory

Patient AssistancePrescription Drug

Programs

of

99120-PhRMA PatAssist.1999 6/18/99 4:07 PM Page i

INTRODUCTION

The research-based pharmaceutical industry has had a long-standing tradition ofproviding prescription medicines free of charge to physicians whose patients mightnot otherwise have access to necessary medicines.

To make it easier for physicians to identify the growing number of programs availablefor needy patients, member companies of the Pharmaceutical Research andManufacturers of America (PhRMA) created this directory. It lists company programsthat provide drugs to physicians whose patients could not otherwise afford them.The programs are listed alphabetically by company. Under the entry for each programis information about how to make a request for assistance, what prescriptionmedicines are covered, and basic eligibility criteria.

Common Questions About This Directory

Q. Who determines whether a medication is listed in the PhRMA Directory?

A. Pharmaceutical manufacturers who belong to PhRMA decide which medicationsto list.

Q. What does it mean if this Directory does not list a medication?

A. If a particular medication is not listed, the drug may not be available under thisprogram or may not be manufactured by a company belonging to PhRMA. PhRMAdoes not have access to information about indigent programs offered by non-membercompanies.

Q. What are the eligibility criteria for the program? How does one apply?

A. Each company determines the eligibility criteria for its program. Eligibility criteriaand application processes vary. Basic eligibility criteria are listed in the directory. Ifyou do not find the answer to your question here, you should contact the drugmanufacturer directly. Telephone numbers are listed in the directory. For numbers ofcompanies not listed here, consult a Physician’s Desk Reference (PDR).

Q. Can PhRMA provide products directly to patients and/or health care providers?

A. Release of prescription drugs is subject to numerous federal and state laws.PhRMA is not permitted to dispense or ship pharmaceutical products.

While these programs of America’s pharmaceutical research companies areindispensable for the neediest patients, they cannot be expected to solve the largernational problem of access to medical care, including prescription drugs. Thepharmaceutical industry will continue to work cooperatively with those seekingpublic and private sector solutions to these larger problems.

© 1999 Pharmaceutical Research and Manufacturers of America

99120-PhRMA PatAssist.1999 6/18/99 4:07 PM Page iii

TABLE OF CONTENTS

Abbott Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Agouron Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1ALZA Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Amgen Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2AstraZeneca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Bayer Corporation Pharmaceutical Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Biogen, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Boehringer Ingelheim Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Bristol-Myers Squibb Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Ciba Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6DuPont Pharmaceuticals Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Eisai Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Elan Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Fujisawa Healthcare, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Genentech, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Genetics Institute, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Genzyme Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Gilead Sciences, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Glaxo Wellcome Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Hoechst Marion Roussel, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Janssen Pharmaceutica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Knoll Pharmaceutical Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Lederle Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Eli Lilly and Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12The Liposome Company, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Merck & Co., Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Novartis Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Ortho Biotech Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Ortho Dermatological . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Ortho-McNeil Pharmaceutical, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Parke-Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Pasteur Mérieux Connaught . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Pfizer Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Pharmacia & Upjohn, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Procter & Gamble Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Rhône-Poulenc Rorer Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Roche Laboratories, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Roxane Laboratories, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Sandoz Pharmaceutical Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Sanofi Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Schering Laboratories/Key Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Searle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Serono Laboratories, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Sigma-Tau Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26SmithKline Beecham Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Solvay Pharmaceuticals, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283M Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Wyeth-Ayerst Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Zeneca Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

99120-PhRMA PatAssist.1999 6/18/99 4:07 PM Page v

ABBOTTLABORATORIESName Of ProgramUninsured Patient Program

Physician Requests Should BeDirected ToAbbott LaboratoriesUninsured Patient Program200 Abbott Park Road, D31C, J23Abbott Park, IL 60064-6163(800) 222-6883 (option 1)

Product(s) Covered By ProgramDepakote, Gabitril, Norvir and Biaxin(Biaxin program available to patients w/MAC, MAI or HIV)

EligibilityAbbott Laboratories uninsured patientprogram is available to outpatients whodo not have insurance reimbursementfor prescriptions and are not eligible forgovernmental assistance programs (i.e.,Medicaid, ADAP).

Other Program InformationThe licensed prescribers office contactsAbbott Laboratories to request anapplication on the behalf of a patient.An application is sent to the prescriberfor completion. Upon receipt of acompleted application we will send theprescriber notification regarding thepatient’s eligibility. If approved,medication will only be shipped to theprescriber’s office.

AGOURONPHARMACEUTICALS, INC.Name Of ProgramVIRACEPT® Assistance Program (VAP)

Physician Requests Should BeDirected ToVIRACEPT® Assistance Program (888) 777-6637

Product(s) Covered By ProgramVIRACEPT® (nelfinavir mesylate)

EligibilityEligibility is determined on a case-by-case basis and takes into considerationan individual’s circumstances. Potentialapplicant or representative may contactthe VAP at 1-888-777-6637 between9am and 6pm EST. Applications aremailed to the physician’s office.

Other Program InformationOnce eligibility is determined, amonthly supply is sent to thephysician’s office. Enrollees must re-enroll every four months.

ALZA PHARMACEUTICALS

Name Of ProgramIndigent Patient Assistance Program

Physician Requests Should BeDirected ToIndigent Patient Assistance Programc/o Comprehensive Reimbursement

Consultants (CRC)8990 Springbrook Drive, Suite 200Minneapolis, MN 55433(800) 577-3788

Product(s) Covered By ProgramBicitra, Ditropan, Ditropan XL, Elmiron,Mycelex, Neutra-Phos, Neutra-Phos-K,Ocusert, PolyCitra, PolyCitra-K,Progestasert, Testoderm, Urispas

EligibilityEligibility is determined by ALZAPharmaceuticals and is based onpatient’s insurance status and incomelevel. Patients must be ineligible forany other third-party reimbursement orsupport program to apply for theIndigent Patient Assistance Program.

Other Program InformationThe physician must request anIndigent Patient Assistance applicationfrom ALZA Pharmaceuticals.

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AMGEN INC.Name Of ProgramSAFETY NET® Program for EPOGEN®

Physician Requests Should BeDirected ToAmgen SAFETY NET® Program forEPOGEN®

(800) 272-9376

Product(s) Covered By ProgramEPOGEN® (Epoetin alfa)

EligibilityFor patients on dialysis only. Amgen’sSAFETY NET® Program is designed toassist those patients who are medicallyindigent (patients may be uninsured orunderinsured). Eligibility is based onpatient’s insurance status and incomelevel. To enroll a patient, providersshould contact the Amgen SAFETYNET® Program by calling (800) 272-9376.

Other Program InformationProviders apply on behalf of thepatient. Any dialysis center, physician,hospital or home dialysis supplier maysponsor a patient by applying to theprogram on his or her behalf. Theprogram is based on a 12-month patientyear rather than on a calendar year.Phone-in or written applications areacceptable for program enrollment.

• • •

Name Of ProgramSAFETY NET® Program forINFERGEN®

Physician Requests Should BeDirected ToAmgen SAFETY NET® Program for INFERGEN®

(888) 508-8088

Product(s) Covered By ProgramINFERGEN® (Interferon alfacon-1)

EligibilityFor patients with chronic hepatitis Conly. Amgen’s SAFETY NET® Programis designed to assist those patients whoare medically indigent. Eligibility isbased on patient’s insurance status andincome level. To enroll a patient, thepatient or provider should contact theAmgen SAFETY NET® Program bycalling (888) 508-8088.

Other Program InformationProviders may enroll a patient or thepatient may enroll him or herself. Anyadministering physician, hospital,community pharmacy or home healthcompany may sponsor a patient byapplying to the program on his or herbehalf. The program is based on a 12-month patient year rather than on acalendar year. Phone-in or writtenapplications are acceptable for programenrollment.

• • •

Name Of ProgramSAFETY NET® Program forNEUPOGEN®

Physician Requests Should BeDirected ToAmgen SAFETY NET® Program forNEUPOGEN®

(800) 272-9376

Product(s) Covered By ProgramNEUPOGEN® (Filgrastim)

EligibilityAmgen’s SAFETY NET® Program isdesigned to assist those patients whoare medically indigent (patients may beuninsured or underinsured). Eligibilityis based on patient’s insurance statusand income level. To enroll a patient,providers should contact the AmgenSAFETY NET® Program by calling (800) 272-9376.

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Other Program InformationProviders apply on behalf of thepatient. Any administering physician,hospital, home health company, orcommunity pharmacy may sponsor apatient by applying to the program onhis or her behalf. The program is basedon a 12-month patient year rather thanon a calendar year. Phone-in or writtenapplications are acceptable for programenrollment.

ASTRAZENECAName Of ProgramAstraZeneca LP Patient AssistanceProgram

Physician Requests Should BeDirected ToAstraZeneca PatientAssistance Program(800) 355-6044

Product(s) Covered By ProgramATACAND® (candesartan cilexetil),EMLA® Anesthetic Disc (lidocaine2.5% and prilocaine 2.5% cream),EMLA® CREAM (lidocaine 2.5% andprilocaine 2.5% ), LEXXEL® (enalaprilmaleate-felodipine ER), PLENDIL®

(felodipine), PRILOSEC®

(omeprazole), TONOCARD®

(tocainide HCl), TOPROL-XL®

(metoprolol succinate)

EligibilityThe AstraZeneca Patient AssistanceProgram is available to qualifiedpatients with a demonstrated medicaland financial need, who have exhaustedthird-party insurance and/or aid fromMedicaid and social agencies, and whodo not have other means to pay fortheir medication.

Other Program InformationThe physician’s office must apply onbehalf of a patient. An application ismailed to the physician, or other healthcare professional with prescribingauthority, for his/her signature. Uponreceipt and approval of a completedapplication, a three-month supply ofmedication will be shipped to thephysician’s office on the patient’s behalfin approximately two weeks.

• • •

Name Of ProgramFOSCAVIR® Assistance andInformation on Reimbursement(F.A.I.R.)

Physician Requests Should BeDirected ToState and Federal Associates1101 King StreetAlexandria, VA 22314(800) 488-FAIR (3247)(703) 683-2239 (fax)

Product(s) Covered By ProgramFOSCAVIR® (foscarnet sodium)Injection

EligibilityIf the patient is not covered foroutpatient prescription drugs underprivate insurance or a public program,the patient’s income must fall belowthe level selected by the company. Ifthe patient has insurance coverage foroutpatient prescription drugs, he or shemay be eligible for assistance withdeductibles or maximum benefit limits.Eligibility is determined by thecompany based on income informationprovided by the physician.

Other Program InformationReferral must be made by thephysician.

• • •

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Name Of ProgramZeneca Pharmaceuticals FoundationPatient Assistance Program

Physician Requests Should BeDirected ToPatient Assistance ProgramZeneca Pharmaceuticals FoundationP.O. Box 15197Wilmington, DE 19850-5197(800) 424-3727

Product(s) Covered By ProgramACCOLATE® (zafirlukast) Tablets, ARIMIDEX® (anastrozole) Tablets, CASODEX® (bicalutamide) Tablets, NOLVADEX® (tamoxifen citrate)Tablets, SEROQUEL® (quetiapinefumarate) Tablets, SORBITRATE®

(isosorbide dinitrate) Oral Tablets USP, SULAR® (nisoldipine) Tablets, TENORETIC® (atenolol andchlorthalidone) Tablets, TENORMIN® (atenolol) Tablets, ZESTORETIC® (lisinopril andhydrochlorothiazide) Tablets, ZESTRIL® (lisinopril) Tablets, ZOLADEX® (goserelin acetateimplant), ZOMIG® (zolmitriptan)Tablets

EligibilityPatient applications are evaluated on a case-by-case basis by the ZenecaPharmaceuticals Foundation. Eligibilityis based on income level/assets andabsence of outpatient private insurance,third-party coverage, or participation in a public program. Income eligibilityis based upon multiples of the U.S. poverty level adjusted forhousehold size.

Other Program InformationReapplication is required every 12months. A reapplication is automaticallysent to enrolled patients. Patient/familymembers/physician can obtainapplication forms from the ZenecaPharmaceuticals Foundation by calling1-800-424-3727. Physicians also canobtain a packet of applications fromtheir Zeneca sales representative.Enrollment in the program requires avalid Social Security Number. Inaddition, the dosage of the medicationmust conform to FDA approved/labeledindications and dosage regimens. A $5.00 shipping and handling fee inthe form of a money order or credit cardis required with each prescription for allproducts except SEROQUEL.

BAYER CORPORATIONPHARMACEUTICALDIVISIONName Of ProgramBayer Indigent Patient Program

Physician Requests Should BeDirected ToBayer Indigent ProgramP.O. Box 29209Phoenix, AZ 85038-9209(800) 998-9180

Product(s) Covered By ProgramMost Bayer pharmaceutical prescriptionmedications used as recommended inprescribing information

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EligibilityPatient must be a U.S. resident.Physician must certify patient is noteligible for, or covered by, government-funded reimbursement or insuranceprogram for medication; patient is notcovered by private insurance; andpatient’s household income is belowfederal poverty-level guidelines.Physician must indicate condition forwhich drug is to be prescribed andcertify that drug will be used forindicated use only. Physician mustagree to follow patient through therapy.All applications are subject to a case-by-case evaluation by Bayer Corporation.

Other Program InformationPatient/physician can qualify over thephone by calling (800) 998-9180. If allinformation needed is obtained over thephone, approval or denial is givenimmediately. If patient is approved, anapplication is generated and sent to thephysician’s office for signatures.

BIOGEN, INC.Name Of Program Avonex® Access Program

Physician Requests Should BeDirected To Avonex® Support Line(800) 456-2255

Product(s) Covered By ProgramAvonex® (interferon beta-1a)

EligibilityEligibility is based on patient’sinsurance status and income level.

BOEHRINGER INGELHEIMPHARMACEUTICALS, INC.Name Of ProgramPartners in Health

Physician Requests Should BeDirected To Partners in HealthBoehringer Ingelheim Pharmaceuticals,Inc. (BIPI)P.O. Box 368Ridgefield, CT 06877-0368(800) 556-8317 (for information andform)

Product(s) Covered By ProgramALUPENT® MDI, ATROVENT®,CATAPRES-TTS®, COMBIVENT®,FLOMAX®, MEXITIL®, MICARDIS®,SERENTIL® for FDA-approvedindications only

EligibilityEligibility to be determined solely by BIPI. Patient must be a U.S. citizen ineligible for prescriptionassistance through Medicaid or private insurance. Patient must meet established financial criteria.

Other Program InformationAll requests are reviewed and approvedon a case-by-case basis. Applicationform, prescription, and patient’s incomedocumentation are required. Maximumof three months supply may beprovided per request. Completefinancial re-application is requiredannually. Renewal requests within thesame year require only the applicationform and a prescription.

Program is subject to change withoutnotice. Current program specifics canbe obtained by calling the toll-freenumber above.

BRISTOL-MYERS SQUIBBCOMPANYName Of ProgramBristol-Myers Squibb Patient AssistanceProgram

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Physician Requests Should BeDirected ToBristol-Myers Squibb Patient Assistance ProgramP.O. Box 4500Princeton, NJ 08543-4500Mailcode P25-31(800) 332-2056; (609) 897-6859 (fax)

Product(s) Covered By ProgramMany Bristol-Myers Squibbpharmaceutical products

EligibilityThis program is designed to providetemporary assistance to patients with afinancial hardship who are not eligiblefor prescription drug coverage throughMedicaid or any other public or privatehealth program. Patients who meet theprogram’s eligibility criteria areprovided BMS products free of charge.

Other Program InformationPhysicians and other health careprofessionals who are interested inenrolling a patient should call the toll-free number above to request anapplication form.

CIBA PHARMACEUTICALS(Please see Novartis Pharmaceuticals, page 14).

DUPONTPHARMACEUTICALSCOMPANYName Of ProgramDuPont Pharmaceuticals CompanyPatient Assistance Program

Physician Requests Should BeDirected ToMichelle PaoliDuPont Pharmaceuticals Company Chestnut Run Plaza,Hickory Run Bldg.974 Centre RoadWilmington, DE 19805(800) 474-2762

Product(s) Covered By ProgramAll marketed non-controlledprescription products

EligibilityEligibility is based on the patient’sinsurance status and income level/assets.Patients should have exhausted all third-party insurance, Medicaid,Medicare, and all other availableprograms. The patient must be aresident of the United States.

Other Program InformationThe physician should request anapplication by calling 1-800-474-2762,prompt 5. The physician mustcomplete and sign the physician-designated area of the application and include a signed, completedprescription. The patient mustcomplete and sign the patient-designated area of the application. The application should be mailed to the address above. It takesapproximately two weeks from receipt of an approved application fordelivery of medication to the physician.

EISAI INC.Name Of ProgramAricept® (donepezil HCI) Patient Assistance Program

Physician Requests Should BeDirected ToThe Aricept® Patient AssistanceProgram (800) 226-2072

Product(s) Covered By ProgramAricept® (donepezil HCI) 5mg and 10 mg tablets

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EligibilityEisai Inc. and Pfizer Inc have developedthe Aricept Patient Assistance Program for those U.S. residents without prescription drug coveragethrough either public or privateinsurance. Aricept® will be provided free of charge to patients who meet the following criteria:

Patient has no insurance or other third-party payer prescription drug coverage,including Medicaid coverage orMedicare managed care coverage.Patient’s annual income must fall withina predetermined range. Patient must bediagnosed by a physician as having mildto moderate dementia of theAlzheimer’s type.

Other Program InformationPatient must requalify after 90-dayinitial supply.

ELAN PHARMACEUTICALS,INC.Name Of ProgramElan Pharmaceuticals PrescriptionAssistance Program

Physician Requests Should BeDirected ToElan Pharmaceuticals PrescriptionAssistance Programc/o Athena Rx Home Pharmacy800 Gateway BoulevardSouth San Francisco, CA 94080(800) 528-4362 (patients)(800) 621-4835 (physicians/staff only)

Product(s) Covered By ProgramPermax® (pergolide mesylate),Zanaflex® (tizanadine hydrochloride),Diastat® (diazepam rectal gel),Mysoline® (primidone), Naprelan® (naproxen sodium)

EligibilityThe patient must be a resident of theUnited States, have a net worth lessthan $30,000 and no third-partyprescription drug coverage.

Other Program InformationThe prescribing physician and patientmust provide the following to AthenaRx Home Pharmacy: a letter of denial from the state Medicaid program; the patient’s most recent income tax return, three consecutive bankstatements or financial statements fromthe same account; a letter on thephysician’s letterhead requesting themedication and assurance on financialneed; and a prescription for a one-yearsupply. Once the request is approved, the product will be shipped quarterly tothe patient via UPS delivery. New requests must be filed foradditional product.

FUJISAWA HEALTHCARE,INC.Name of ProgramPrograf™ Patient Assistance Program

Physician Requests Should BeDirected ToPrograf™ Patient Assistance Programc/o Medical Technology HotlinesSM

P.O. Box 7710Washington, DC 20044-7710(800) 4-PROGRAF(800) 477-6472, or (202) 393-5563 inthe Washington, DC area

Product(s) Covered By ProgramPrograf™ capsules (tacrolimus, FK506)

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EligibilityFujisawa Healthcare, Inc. developed thePrograf™ Patient Assistance Program tohelp improve access to oral Prograf™ forpatients who have no health insurancefor Prograf™ and limited financialresources. To be eligible for theprogram, patients must meet incomeand insurance criteria set by FujisawaHealthcare. Please call the Prograf™Reimbursement Hotline (800-4-PROGRAF) for an application or forinformation about eligibility. If youdescribe a patient’s insurance andfinancial situation, Hotline staff candetermine whether the patient is likelyto qualify for the Prograf™ PatientAssistance Program.

Other Program InformationTo enroll a patient, physicians mustfirst register with the program.Registered physicians may enrollpatients by submitting a patientenrollment form and a prescription. If approved, the patient will receivetwo 90-day shipments of Prograf™ from a mailorder pharmacy affiliatedwith the program. The pharmacy will bill the patient $20 per shipmentfor expenses associated with dispensingand shipping the product. If continuedassistance is required after six months, the physician must reapply for the patient.

GENENTECH, INC.Name Of ProgramUninsured Patient Assistance Program

Physician Requests Should BeDirected ToGenentech, Inc.P.O. Box 2586Mail Stop #13S. San Francisco, CA 94083-2586(800) 879-4747, (415) 225-1366 (fax)

Product(s) Covered By ProgramActivase® (alteplase recombinant),Herceptin® (trastuzumab), Protropin®

(somatrem for injection), Nutropin®

(somatropin for injection), NutropinAQ™ (somatropin for injection),Rituxan® (rituximab)

EligibilityA completed application form must besubmitted for all products and mustcontain required medical, financial, andinsurance information. The requiredinformation for Nutropin®, NutropinAQ™, Protropin®, and Rituxan™applications is provided by the physicianand patient. Required information forActivase® is provided by the hospital.Required information for Rituxan™ isprovided by the prescribing physician.For consideration for any of theprograms, the patient must not beeligible for public or private insurancereimbursement. Specifically forActivase®, the patient must have anannual gross income of $25,000 or less.Once patient eligibility has been verifiedfor Nutropin®, Nutropin AQ™, andProtropin®, future shipments will bedirected to the physician’s office onbehalf of the patient. Once patienteligibility has been verified for Activase®

and Rituxan™, Genentech will providereplacement of the amount of productused to treat the patient. Theseprograms may be subject to change.

GENETICS INSTITUTE, INC.Name Of ProgramThe BENEFIX Reimbursement andInformation Program

Physician Requests Should BeDirected To(888) 999-2349

Product(s) Covered By ProgramBenefix™ Coagulation Factor IX(recombinant)

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EligibilityThe program is designed to providetemporary assistance to patients whomeet the pre-determined eligibilitycriteria. Eligible patients must bewithout prescription drug coverage froma third-party payer. Patients who meetthe eligibility criteria are eligible for aperiod of 90 days, at which time theymust requalify for the program.

Other Program InformationApplication forms are sent to physicianswho are treating specific patients whomay qualify for the program.Application forms must be signed by the patient and physician prior toreturning to the program at 1101 King Street, Suite 600, Alexandria, VA 22314.

• • •

Name Of ProgramNeumega® Access Program

Physician Requests Should BeDirected ToThe Neumega® Access Program(888) NEUMEGA (638-6342)

Product(s) Covered By ProgramNeumega® (oprelvekin)

EligibilityFor uninsured and underinsuredpatients who have limited financialresources.

Other Program InformationReimbursement specialists provideassistance to physicians, nurses, officemanagers, pharmacists and patients with insurance reimbursement, such as information on billing and coding.Service staff will also provideindividualized help with claims filing and preauthorization requests and provide support in challenging claim denials.

GENZYME CORPORATIONName Of ProgramCeredase® / Cerezyme® Access Program(CAP Program) Established by the Genzyme CharitableFoundation

Physician Requests Should BeDirected ToWytske Kingma, M.D.Medical AffairsGenzyme Corp.One Kendall SquareCambridge, MA 01239-1562(800) 745-4447, ext. 7808

Product(s) Covered By ProgramCeredase® (alglucerase injection),Cerezyme® (imiglucerase for injection)

EligibilityBased on financial and medical need.Must be uninsured and lack thefinancial means to purchase the drug.In order to maintain eligibility, patientsand their families are expected tocontinue exploring alternative fundingoptions with the Genzyme CaseManagement Specialist. These optionsinclude private insurance, governmentprograms and/or charitable sources.

Other Program InformationThe CAP Program is considered atemporary funding program.

GILEAD SCIENCES, INC.Name Of ProgramGilead Sciences Support Services

Physician Requests Should BeDirected ToGilead Sciences Support Services1-800-Gilead 5 (445-3235)or fax 1-713-760-0049(9:00 a.m. to 5:30 p.m. Eastern Time)

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Product(s) Covered By ProgramVISTIDE® (cidofovir injection), for thetreatment of cytomegalovirus (CMV)retinitis in patients with AIDS

EligibilityGilead Sciences Support Services isdesigned to assist both insured anduninsured patients in receivingreimbursement for VISTIDE. Todetermine eligibility for this program,physicians or patients may request aPatient Assistance Program applicationfor VISTIDE and mail or fax thecompleted form to Gilead SciencesSupport Services.

Other Program InformationThe Support Services program offersinsurance claims assistance, referrals forfinancial support, referrals to AIDSservice agencies. Support specialistsconsult with insured patients and theirphysicians regarding prior authorizationor third-party insurance claims, contactinsurance companies on behalf ofpatients and contact patients andphysicians to offer appeal procedures.

GLAXO WELLCOMEINC.Name Of ProgramGlaxo Wellcome Patient AssistanceProgram

Physician Requests Should BeDirected ToGlaxo Wellcome Inc.Patient Assistance ProgramP.O. Box 52185Phoenix, AZ 85072-2185(800) 722-9294 (800) 750-9832 (fax)

Additional Program Information Can BeFound At:www.glaxowellcome.com/papProgram materials may also be ordered byhealth professionals through this website.

Product(s) Covered By ProgramAll marketed Glaxo Wellcomeprescription products

EligibilityGlaxo Wellcome is dedicated toassuring that no one is denied access toour marketed prescription products as aresult of an inability to pay. The PatientAssistance Program is intended to servepatients who do not qualify for or havedrug benefits through private insuranceor government-funded programs. ThePatient Assistance Program is notintended to replace government-sponsored programs.

The Patient Assistance Program isdesigned as an interim solution to assistfinancially disadvantaged individualsuntil alternative funding can be found.Income eligibility is based uponmultiples of the federal poverty leveladjusted for household size. Theprovision of free medication is aphilanthropic activity by GlaxoWellcome, and therefore, the PatientAssistance Program is considered thepayer of last resort.

Other Program InformationThis program is available only topatients treated in an outpatientsetting. All completed applications willbe reviewed against the company’sestablished criteria on a case-by-casebasis. Enrolled patients are eligible toreceive up to 90 continuous days ofdrug therapy with nominal copayments.Program benefits for outpatientproducts are provided throughpharmacies. Injectable products areprovided to the health care provider viadirect product shipment.

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HOECHST MARIONROUSSEL, INC.Name Of ProgramPatient Assistance Program

Physician Requests Should BeDirected ToPatient Assistance ProgramHoechst Marion Roussel, Inc.P.O. Box 9950Kansas City, MO 64134-0950(800) 221-4025

Product(s) Covered By ProgramAll prescription products manufacturedby Hoechst Marion Roussel, exceptTenuate

EligibilityDetermined by the physician based onpatient’s income level and lack ofprescription coverage. The intent of theprogram is to provide access to productsfor patients who are legal U.S.residents, fall below the federal povertylevel and have no other means ofprescription coverage, i.e., private orpublic assistance. The program isrestricted to indigent patients.

Other Program InformationNecessary forms are provided by thecompany and are sent only to thephysician. In most cases, a three-month supply of product is availableat any one time.

• • •

Name Of ProgramThe Anzement Patient AssistanceProgram and the AnzementReimbursement Program

Physician Requests Should BeDirected ToAnzement Patient Assistance Programc/o Comprehensive ReimbursementConsultants (CRC)8990 Springbrook Drive, Suite 200Minneapolis, MN 55433(888) 259-2219

JANSSEN PHARMACEUTICAName of ProgramJanssen Patient Assistance Program

Physician Requests Should BeDirected ToJanssen Patient Assistance Program1800 Robert Fulton DriveReston, VA 20191-4346(800) 544-2987

Product(s) Covered By ProgramJanssen’s medical prescription products

EligibilityProgram will ensure that all of Janssen’sprescription products [Duragesic®

(fentanyl transdermal), Ergamisol®

(levamisole), Hismanal® (astemizole),Imodium® (loperamide), Nizoral® Cream(ketaconazole cream), Nizoral® Shampoo(ketaconazole shampoo), Nizoral® Tablet(ketaconazole tablet), Propulsid®

(cisapride), Sporanox® (itraconazole),Vermox® (mebendazole)] will be free ofcharge to any persons who meet specificmedical criteria and lack financialresources and third-party insurancenecessary to obtain treatment.Reimbursement specialist determineseligibility for each patient. Janssenrequests that physicians not chargepatients beyond insurance coverage forprofessional services.

Other Program InformationOne or two months’ supply available;varies by product.

• • •

Name Of ProgramThe Risperdal Patient AssistanceProgram and The RisperdalReimbursement Support Program

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Physician Requests Should BeDirected ToJanssen CaresThe Risperdal Patient AssistanceProgram4828 Parkway Plaza Blvd., Suite 220Charlotte, NC 28217-1969(800) 652-6227, Monday through Friday(9:00 a.m. to 5:00 p.m. E.T.)(704) 357-0036 (fax)

EligibilityProgram will ensure that allRISPERDAL® (risperidone) is madeavailable free of charge to any personswho meet specific medical criteria andlack financial resources and third-partyinsurance necessary to obtaintreatment. Reimbursement specialistdetermines eligibility for each patient.Janssen requests that physicians notcharge patients beyond insurancecoverage for professional services.

The Risperdal Reimbursement SupportProgram is designed to answerphysicians’ and patients’ questions andsolve problems related to Risperdalreimbursement as efficiently andquickly as possible.

KNOLL PHARMACEUTICALCOMPANYName Of ProgramKnoll Indigent Patient Program

Physician Requests Should BeDirected ToKnoll Indigent Patient ProgramKnoll Pharmaceutical Company3000 Continental Drive, NorthMount Olive, NJ 07828-1234Attn: Telemarketing

Product(s) Covered By ProgramIsoptin® SR (verapamil HCl), Mavik(trandolapril), Rythmol® (propafenoneHCl), Collagenase Santyl, Synthroid®

Tablets (levothyroxine sodium, USP),Tarka (trandolapril and verapamil)

EligibilityPhysician must submit appropriatedocumentation proving patientindigence to company.

Other Program InformationDecisions are made on a case-by-casebasis. Prescription is required for everyrequest. Maximum of three-monthsupply on any one request.

LEDERLE LABORATORIES(Please see Wyeth-Ayerst LaboratoriesIndigent Patient Program on page 29.)

ELI LILLY AND COMPANYName Of ProgramLilly Cares

Physician Requests Should BeDirected ToLilly Cares Program AdministratorEli Lilly and CompanyP.O. Box 25768Alexandria, VA 22313(800) 545-6962

Product(s) Covered By ProgramMost Lilly prescription products andinsulins (except controlled substances)are covered by this program. Gemzar® iscovered under a separate program.

EligibilityPatients must be U.S. residents.Eligibility is determined on a case-by-case basis in consultation with eachprescribing physician. Eligibility is based on the patient’s inability to payand lack of third-party drug paymentassistance, including insurance,Medicaid, government-subsidizedclinics, and other government,community, or private programs. Inpatients and those who can obtaindrug reimbursement from any source are not eligible. Requests forreplacement drugs cannot be honored. Medications are provided directly to the

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physician for dispensing to the patient.Quantity of supply is dependent upontype of product being prescribed. AllLilly medications must be used asrecommended in product labeling.

Other Program InformationForms to qualify a patient for theprogram will be provided to thephysician. On this form, the physician is requested to provide prescriptioninformation, including signature andDEA number, and to confirm thepatient’s ineligibility for other forms of outpatient drug coverage.

Additionally, the patient is requested to provide pertinent information andstate financial need.

Subsequent request for same patientrequires another prescription andrestatement of medical and financialneed. Program guidelines may besubject to change.

• • •

Name Of ProgramGemzar® Patient Assistance Program

Physician Requests Should BeDirected ToGemzar® Reimbursement Hotline(888) 4-GEMZAR (888-443-6927)

Product(s) Covered By ProgramGemzar® (gemcitabine hydrochloride)

EligibilityApplications for the program areavailable by calling the toll-free GemzarHotline. Applicants determined to beeligible based on program incomecriteria will be approved on the basis ofthese additional criteria: no medicalinsurance, and ineligible for anyprograms with a drug benefit provision,including Medicaid, third-partyinsurance, Medicare, and all otherprograms have denied coverage forGemzar in writing, and all appeals havebeen exhausted.

THE LIPOSOME COMPANY,INC. Name Of ProgramFinancial Assistance Program forABELCET®

Physician Requests Should BeDirected ToFinancial Assistance Program forABELCET®

The Liposome Company, Inc.One Research WayPrinceton, NJ 08540-6619(800) 335-5476

Product(s) Covered By ProgramABELCET® (amphotericin B lipidcomplex injection)

EligibilityPatients must be uninsured (not eligibleto receive reimbursement through anyother third-party drug reimbursementprogram, i.e., Medicaid, local or federalagency programs, Blue Cross/BlueShield, private insurance programs andprivate foundations), and are unable topay for the product out-of-pocket.Eligibility is determined by The Liposome Company based onmedical and financial informationprovided on behalf of the patient by the hospital or physician.

Other Program InformationPatients must receive ABELCET®

from a hospital, physician, or homehealth care company for a medicallyappropriate application. Providers mayenroll a patient by calling (800) 335-5476 or by contacting a Liposome AreaSales Manager to obtain an applicationform. Application forms must becompleted and signed by a physicianto enroll a patient.

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MERCK & CO., INC.Name Of ProgramThe Merck Patient Assistance Program

Physician Requests Should BeDirected ToThe Merck Patient AssistanceProgram—Health care professionalswith prescribing privileges may call(800) 994-2111

Product(s) Covered By ProgramMost Merck products. Requests for vaccines and injectables are not accepted, with the exception of requests for anti-cancer injectable products.

EligibilityThe Merck Patient Assistance Programis designed to provide temporaryassistance to patients who have noaccess to any insurance coverage forprescription medications and are trulyunable to afford prescriptionmedications. The patient must haveexhausted all options for prescriptionbenefits and coverage including: privateinsurance, HMOs, Medicaid, Medicare,state pharmacy assistance programs,Veteran’s Assistance, and any othersocial service agency support. Patientsmust also reside in the U.S. and have aU.S. treating physician. Completedapplications are reviewed on a case-by-case basis.

Other Program InformationEach application must be completelyfilled out and signed by both theprescriber and the patient and bemailed with an original, signed, datedprescription with the prescriber’s name,address, professional designation, and aDEA or state license number.

Completed applications are reviewedfor eligibility on a case-by-case basis.Once eligibility has been verified, up toa three-month supply of the prescribed

medication(s) is sent directly to theprescriber’s office for distribution tothe patient. Medications are labeled for the patient.

• • •

Name Of ProgramSUPPORT™Reimbursement Support and PatientAssistance Services for Crixivan®

Physician Requests Should BeDirected ToSUPPORT™Health care professionals or patientsmay call (800) 850-3430

Product(s) Covered By ProgramCrixivan® (indinavir sulfate)

EligibilityThe SUPPORT™ program assistspatients who are prescribed Crixivan®

and are uncertain of their insurancecoverage, in locating payment sourcesfor Crixivan®. Free product is providedto those uninsured patients who qualify,and for whom no alternative source ofcoverage can be identified. Patientsmust also reside in the U.S. and have aU.S. treating physician. All applicationsare reviewed on a case-by-case basis.Product is shipped to the prescriber’soffice for distribution to the patient.Medicine is labeled for the patient.

NOVARTISPHARMACEUTICALSName Of ProgramNovartis Patient Assistance Program

Physician Requests Should BeDirected ToNovartis PharmaceuticalsPatient Assistance ProgramP.O. Box 52052Phoenix, AZ 85072-9170(800) 257-3273

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Product(s) Covered By ProgramCertain single source and/or life-sustaining products. Controlledsubstances are not included.

EligibilityThe Patient Assistance Programprovides temporary assistance topatients who are experiencing financialhardship and who have no prescriptiondrug insurance, until alternative sourcesof funding are obtained. Patients arerequired to complete an applicationalong with their physicians and return itfor evaluation.

Other Program InformationPatient applications are evaluated on acase-by-case basis. Novartis Pharma-ceuticals will be launching a newPatient Assistance Program in January1998. Please call for informationregarding our new procedures or newproducts sponsored in the program.

ORTHO BIOTECH INC.Name Of ProgramProcritline™

Physician Requests Should BeDirected ToProcritline™1250 Bayhill Drive, Suite 300San Bruno, CA 94066(800) 553-3851(800) 683-7855 (fax)Hours of operation: 9:00am–8:00pm EST

Product(s) Covered By ProgramPROCRIT® (Epoetin alfa) for non-dialysis use, LEUSTATIN® (cladribine)Injection

EligibilityProgram will ensure that PROCRIT®

and/or LEUSTATIN® is made availableto any persons who meet specificmedical criteria and lack financialresources and third-party coveragenecessary to obtain treatment. Areimbursement specialist determineseligibility.

Other Program InformationPatient eligibility application forms areavailable by accessing the 800 number(800-553-3851). This call can helpdetermine if a patient is eligible toenroll in the program or is eligible foran alternative program if other sourcesof funding are identified.

ORTHO DERMATOLOGICALName Of ProgramOrtho Dermatological PatientAssistance Program

Physician Requests Should BeDirected ToOrtho Dermatological PatientAssistance ProgramOrtho-McNeil Patient AssistanceProgramP.O. Box 938Somerville, NJ 08876(800) 797-7737

Product(s) Covered By ProgramPrescription products prescribedaccording to approved labeledindications and dosage regimens.

EligibilityPatients should not have insurancecoverage for prescription medication.Patients should not be eligible for othersources of drug coverage; they need tohave applied to public sector programsand been denied. Patients’ income fallsbelow poverty level and retail purchasewould cause hardship.

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Other Program InformationHealth care practitioner should requestan application form. The completedform must be accompanied by a signedand dated prescription. Medication willbe sent to the health care practitionerfor dispensing to the patient.

ORTHO-McNEILPHARMACEUTICAL, INC.Name Of ProgramOrtho-McNeil Patient AssistanceProgram

Physician Requests Should BeDirected ToOrtho-McNeil Patient AssistanceProgramP.O. Box 938Somerville, NJ 08876(800) 797-7737

Product(s) Covered By ProgramPrescription products prescribedaccording to approved labeledindications and dosage regimens

EligibilityPatients should not have insurancecoverage for prescription medication.Patients should not be eligible for othersources of drug coverage; they need tohave applied to public sector programsand been denied. Patients’ income fallsbelow poverty level and retail purchasewould cause hardship.

Other Program InformationHealth care practitioner should requestan application form. The completedform must be accompanied by a signedand dated prescription. Medication willbe sent to the health care practitionerfor dispensing to the patient.

PARKE-DAVISDivision of Warner-Lambert Company

Name Of ProgramParke-Davis Patient Assistance Program

Physician Requests Should BeDirected ToThe Parke-Davis Patient AssistanceProgramP.O. Box 1058Somerville, NJ 08876(908) 725-1247

Product(s) Covered By ProgramAccupril, Cognex, Dilantin, Loestrin,Neurontin, Rezulin, and Zarontin

EligibilityPatients must not be eligible for othersources of drug coverage and must bedeemed financially eligible based oncompany guidelines and physiciancertification.

Other Program InformationPhysicians should request anapplication form from their Parke-DavisSales Representative. The completedform, accompanied by a signed anddated prescription, should be mailed tothe address above. Up to a three-monthsupply will be delivered to thephysician for dispensing to the patient.

• • •

Name Of ProgramLipitor Patient Assistance Program

Physician Requests Should BeDirected ToThe Lipitor Patient Assistance ProgramP.O. Box 1058Somerville, NJ 08876(908) 218-0120

Product(s) Covered By ProgramLipitor (atorvastin calcium)

EligibilityPatients must not be eligible for othersources of drug coverage and must bedeemed financially eligible based oncompany guidelines and physiciancertification.

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Other Program InformationPhysicians should request anapplication form from their Parke-Davisor Pfizer Sales Representative. The completed form, accompanied by a signed and dated prescription,should be mailed to the address above.Up to a three-month supply will bedelivered to the physician fordispensing to the patient.

PASTEUR MÉRIEUXCONNAUGHT Name Of ProgramIndigent Patient Program

Physician Requests Should BeDirected ToCustomer Account ManagementPasteur Merieux ConnaughtDiscovery DriveSwiftwater, PA 18370-0187(800)-VACCINE (800-822-2463)

Product(s) Covered By ProgramIMOVAX® Rabies, rabies vaccine;IMOGAM® Rabies-HT, rabies immuneglobulin (human) (USP); TheraCys®

BCG live intravesical (Note: IMOVAX®

and IMOGAM® Rabies-HT areprovided on a post-exposure basis only)

EligibilityDetermined on a case-by-case basis.Limited to those individuals who havebeen identified as indigent, uninsured,and ineligible for Medicare andMedicaid; is not eligible for otherprograms offered by the state, county orcity; the patient is a U.S. resident;patient’s household income is belowfederal poverty guidelines. Physicianmust waive all fees associated withtreating the patient and certify productwill not be sold, traded, or used for anyother purpose but to treat the patientapplying for assistance.

Other Program InformationPasteur Mérieux Connaught reservesthe right to modify or discontinue theIndigent Patient Program at any timefor any reason. An application formmust be completed, call 1-800-VACCINE to receive an application.Rabies—The physician needs to specifythe quantity of IMOGAM® Rabiesneeded for patient (in mL) as well as the number of doses of IMOVAX®

Rabies, along with the patient’s age and weight.TheraCys®—Six doses are provided forone induction course of therapy.Connaught does provide, under theprogram, for a full course of therapy—induction and maintenance—which may be as high as 11 doses (six doses for induction plus as many as five doses for maintenance) at the physician’s discretion.

PFIZER INCName Of ProgramPfizer Prescription Assistance

Physician Requests Should BeDirected ToPfizer Prescription AssistanceP.O. Box 25457Alexandria, VA 22313-5457(800) 646-4455

Product(s) Covered By ProgramMost Pfizer outpatient products withchronic indications are covered by thisprogram. Aricept®, Diflucan® andZithromax® are covered by separateprograms.

EligibilityAny patient that a physician is treatingas indigent is eligible. Patients musthave incomes below $12,000 (single) or$15,000 (family). Patients must not bereceiving or be eligible for third-party orMedicaid reimbursements formedications. No copayment or cost-sharing is required by the patient.

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Other Program InformationSpecific forms are not required. Thephysician must write a letter on his orher letterhead to Pfizer stating that thepatient meets income criteria and isuninsured for pharmaceuticals andenclose a prescription for the desiredproduct. The letter must be signed bythe prescribing physician. Products are shipped to the physician forredistribution to the patient. Productsare supplied to the physician in stockpackages, usually 100 tablets orcapsules. It may take up to four weeks to receive the product. Refillsare obtained through physicianresubmission of request. Pfizer reserves the right to limit enrollment of patients.

• • •

Name Of ProgramDiflucan® and Zithromax® PatientAssistance Program

Physician Requests Should BeDirected ToDiflucan® and Zithromax® PatientAssistance Program(800) 869-9979

Product(s) Covered By ProgramDiflucan® (fluconazole) andZithromax® (azithromycin) for MACprophylaxis

EligibilityPatient must not have insurance or otherthird-party coverage, includingMedicaid, and must not be eligible for astate’s AIDS drug assistance program.Patient must have an income of less than$25,000 a year without dependents, orless than $40,000 a year withdependents.

Other Program InformationPhysicians should call the Diflucan®

and Zithromax® Patient AssistanceProgram and explain the patient’ssituation to the Patient AssistanceSpecialist. The specialist will then senda short qualifying form that requestsinsurance status, income information,and the amount of Diflucan® orZithromax® the patient will require.The form must be completed, signed, aprescription attached, and returned tothe Patient Assistance Program in theenvelope provided.

The Program staff will determinewhether the patient is eligible for freeDiflucan® or Zithromax® on the sameday the form is received. A letter will besent notifying the physician of thepatient’s eligibility or ineligibility. It may take up to three weeks from theplacement of the first call to the deliveryof the product to physicians. Pfizerreserves the right to limit enrollment of patients.

• • •

Name Of ProgramSharing the Care

Requests Should Be Directed ToSharing the CarePfizer Inc235 E. 42nd StreetNew York, NY 10017-5755(800) 984-1500

Product(s) Covered By ProgramCertain Pfizer single-source products

EligibilityThe program, a joint effort of Pfizer, theNational Governors’ Association, and theNational Association of CommunityHealth Centers, works solely throughcommunity, migrant, and homelesshealth centers that are funded under section 330(e), 330(g), or 330(h) of thePublic Health Service Act and that havean in-house pharmacy. The program

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includes the participation of more than350 health centers throughout theUnited States. To be eligible toparticipate in Sharing the Care, thepatient must be registered at aparticipating health center, must not becovered by any private insurance orpublic assistance coveringpharmaceuticals, must not be Medicaid-enrolled, and must have a family incomethat is equal to or below the federalpoverty level. Pfizer reserves the right tolimit enrollment of patients and healthcenters.

Other Program InformationProduct is dispensed to patient athealth center pharmacy.

• • •

Name Of ProgramAricept® Patient Assistance Program(Please see Eisai Inc. on page 6 forcomplete program information.)

• • •

Name Of ProgramLipitor Patient Assistance Program(Please see Parke-Davis on page 16 forcomplete program information.)

• • •

Name Of Program(A Participant in) the Arkansas HealthCare Access Program

Physician Requests Should BeDirected ToMs. Pat Keller Program DirectorArkansas Health Care AccessFoundationP.O. Box 56248Little Rock, AR 72215(800) 950-8233, (501) 221-3033

Product(s) Covered By ProgramMost Pfizer prescription products arecovered

EligibilityMust be an Arkansas resident to qualify.Eligible individuals are certified by theArkansas Local County Department ofHuman Services as being Arkansasresidents below the federal povertyguidelines, who do not have healthinsurance benefits and do not qualify forany government entitlement programs.No copayment or cost-sharing isrequired from the patient. Physicianmust waive his or her fee for the initialvisit. This program does not apply toindividuals during hospital inpatientstays.

Other Program InformationPhysicians should contact the ArkansasHealth Care Access Foundation forfurther information.

• • •

Name Of Program(A Participant in) the Kentucky HealthCare Access Program

Physician Requests Should BeDirected ToMr. J. Scott JudyExecutive Vice PresidentHealth Kentucky, Inc.12700 Shelbyville RoadLouisville, KY 40243(800) 633-8100, (502) 254-4214 (502) 254-5117 (fax)[email protected] (e-mail)


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EligibilityMust be a Kentucky resident to qualify.Eligible individuals are certified by theKentucky Cabinet for Health Servicesas Kentuckians below the federalpoverty standards who do not havehealth insurance benefits and do notqualify for any government entitlementprograms. No copayment or cost-sharingis required from the patient. Physicianmust waive his or her fee. This programdoes not apply to individuals duringhospital inpatient stays.

Other Program InformationPhysicians should contact HealthKentucky, Inc. for further information.

• • •

Name Of Program(A Participant in) Commun-I-Care

Physician Requests Should BeDirected ToMr. Ken TrogdonDirectorCommun-I-CareP.O. Box 12054Columbia, SC 29211(800) 763-0059, (803) 933-9183


EligibilityEligible individuals must be SouthCarolina residents. Individuals arecertified by Commun-I-Care as belowthe federal poverty line and not coveredby any government entitlementprograms. No copayment or cost-sharingis required from the patient. Physicianmust waive his or her fee.

Other Program InformationPhysicians should contact Commun-I-Care for further information.

PHARMACIA & UPJOHN,INC.Name Of ProgramRxMAP Prescription MedicationAssistance Program

Physician Requests Should BeDirected ToRxMAPP.O. Box 29043Phoenix, AZ 85038(800) 242-7014

Product(s) Covered By ProgramNumerous products

EligibilityBased on federal poverty level and noprescription drug coverage.

Other Program InformationAll inquiries should go to RxMAP at(800) 242-7014.

PROCTER & GAMBLEPHARMACEUTICALS, INC.Physician Requests Should BeDirected ToProcter & Gamble Pharmaceuticals,Inc.P.O. Box 231Norwich, NY 13815Attn: Customer Service Department(800) 448-4878

Product(s) Covered By ProgramActonel 30mg, Alora, Asacol, DantriumCapsules, Didronel, Helidac,Macrodantin, Macrobid

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EligibilityProcter & Gamble Pharmaceuticals has always tried to ensure that allpatients have full access to its products.To qualify, patients should not haveinsurance coverage for prescriptionmedicines or Medicaidreimbursements. The intent of theprogram is to assure access to productsfor patients who fall below the federalpoverty level and have no other means of health care coverage. Eachpatient’s case is handled strictly on an individual basis.

The company relies on the physician’sassessment of need to determineeligibility. Application forms areprovided by the company for thephysician/patient to complete.

An original prescription duly signed bythe attending physician for one of thecompany’s products is required.

Other Program InformationThe quantity of product supplieddepends on diagnosis and need, butgenerally a three month supply isprovided for a chronic medication.Refills require a new prescription andapplication form from the physician. Theprescription medication is sent directlyto the physician, who provides it to thepatient. Applications are good for oneyear. Afterwards, patients must be re-screened to ensure continued eligibility.

RHÔNE-POULENC RORERINC.Name Of ProgramRhône-Poulenc Rorer Patient AssistanceProgram

Physician Requests Should BeDirected ToMedical Affairs / Patient AssistanceProgramRhône-Poulenc Rorer Inc.P.O. Box 5094, 500 Arcola RoadMailstop #4C29Collegeville, PA 19426-0998(610) 454-8110, (610) 454-2102 (fax)

Product(s) Covered By ProgramAll products are included, with somelimitations

EligibilityRhône-Poulenc Rorer’s (RPR) PatientAssistance Program is administered on acase-by-case basis. A patient is eligibleto apply to the program if there is amedical and financial need forassistance as identified by a physician,social agent or agency, and if the effortto obtain assistance from all third-partypayers, Medicaid, Medicare, and otherlocal, state or federal governmentsupport has been exhausted. Thephysician is requested to fill out a formprovided by RPR and to send thecompleted form along with a validprescription to the above address.Determination of eligibility is made bythe company based on the informationin the completed form. Once eligibilityhas been determined, the prescribedmedication is sent to the physician fordispensing to the patient.

Other Program InformationSubsequent requests for the samepatient require an additionalprescription and completion of thePatient Assistance Form forconfirmation that the patient’s statushas not changed. Photocopies are not acceptable. This program willcontinue to be reviewed andmodifications will be made to meet the changes occurring in the health careenvironment as related to the needs ofindigent patients.

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ROCHE LABORATORIES,INC.A Division of Hoffmann-La Roche Inc.Roche Products Inc.

Name Of ProgramRoche Medical Needs Program

Physician Requests Should BeDirected ToRoche Medical Needs ProgramRoche Laboratories, Inc.340 Kingsland StreetNutley, NJ 07110(800) 285-4484

Product(s) Covered By ProgramRoche product line with someexceptions

EligibilityThe Roche Medical Needs Program isdesigned as an interim solution forpatients who lack third-party outpatientprescription drug coverage underprivate insurance, government-fundedprograms (Medicaid, Medicare,Veterans Affairs, etc.), orprivate/community sources and areunable to afford to purchase ourproducts on their own.

Roche offers the Medical NeedsProgram as a philanthropic endeavor toassure access to Roche products forneedy patients at no charge untilalternative funding can be found. TheRoche Medical Needs Program is partof Roche’s commitment to assure accessto our products and is not intended tosupplant or replace prescription drugcoverage provided by third-party publicor private payers.

This program is for individualoutpatients who meet the MedicalNeeds Program criteria and is offeredthrough licensed practitioners. Theprogram is not intended for clinics,hospitals, and/or other institutions.

Other Program InformationRoche Medical Needs Program formsobtained from the Medical NeedsDepartment are required. Applicationsare provided only to licensedpractitioners. Physicians’ and patients’signatures and a DEA number arerequired on the application. A newapplication form must be completedfor patients requiring refills. Allcompleted applications will bereviewed and approved by Roche on acase-by-case basis using theestablished criteria of the program.Patients and providers may berequested to participate inreimbursement case managementbased on the product requested. Up toa three-month supply of product willbe shipped directly to the licensedpractitioner within two to three weeks.

• • •

Name Of ProgramRoche Medical Needs Program forCellCept® (mycophenolate mofetil),CYTOVENE® (ganciclovir capsules),and CYTOVENE®-IV (ganciclovirsodium for injection)

Physician Requests Should BeDirected ToRoche Transplant ReimbursementHotline(800) 772-5790

Product(s) Covered By ProgramCellCept® (mycophenolate mofetil),CYTOVENE® (ganciclovir capsules),and CYTOVENE®-IV (ganciclovirsodium for injection). CYTOVENEproducts for use with transplantpatients

• • •

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Name Of ProgramRoche Medical Needs Program forFORTOVASE™ (saquinavir),INVIRASE® (saquinavir mesylate),CYTOVENE® (ganciclovir capsules),CYTOVENE®-IV (ganciclovir sodiumfor injection), and HIVID®

(zalcitabine)

Physician Requests Should BeDirected ToRoche HIV Therapy Assistance Program(800) 282-7780

Product(s) Covered By ProgramFORTOVASE™ (saquinavir),INVIRASE® (saquinavir mesylate),CYTOVENE® (ganciclovir capsules),CYTOVENE®-IV (ganciclovir sodiumfor injection), and HIVID®

(zalcitabine). CYTOVENE products foruse with HIV/AIDS patients

• • •

Name Of ProgramRoche Medical Needs Program forRoferon®-A (Interferon alpha-2a,recombinant), Vesanoid® (tretinoin), and Fluorouracil Injection

Physician Requests Should BeDirected ToOncoline™/Hepline™ ReimbursementHotline(800) 443-6676 (press 2 or 3)

Product(s) Covered By ProgramRoferon®-A (Interferon alpha-2a,recombinant), Vesanoid® (tretinoin), and Fluorouracil Injection

ROXANE LABORATORIES,INC.Name Of ProgramPatient Assistance Program

Physician Requests Should BeDirected ToNexus Healthcare4161 Arlingate PlazaColumbus, OH 43228(800) 274-8651

Product(s) Covered By ProgramDuraclon; Marinol® (dronabinol)Capsules 2.5 mg; Oramorph SR®

(morphine sulfate sustained release)Tablets 15 mg, 30 mg, 60 mg, and 100mg; Roxanol™ (morphine sulfateconcentrated oral solution) 20 mg/mland 120 ml bottles; Roxanol 100™(morphine sulfate concentrated oralsolution) 100 mg/5 ml and 240 mlbottles; Roxicodone (oxycodone)Tablets 5 mg; Oral solution 5 mg/5 ml;Roxicodone Intensol™ 20 mg/ml;Viramune® (nevirapine)

EligibilityProduct will be provided free of chargeto patients through their pharmacist,provided the patient is uninsured andmeets annual income requirements.

Other Program InformationPhysicians should call the toll-freenumber to discuss their patient’seligibility with a program representative.If the patient appears to meet the eligibility requirements, a QualificationForm will be mailed to the physician. If eligible, patients can obtain their Duraclon, Marinol®, OramorphSR®, Roxanol™, Roxicodone, orViramune® therapies through aparticipating pharmacy.

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SANDOZ PHARMACEUTICALCORPORATION(Please see Novartis Pharmaceuticals, page 14).

SANOFIPHARMACEUTICALSName Of ProgramNeedy Patient Program

Physician Requests Should BeDirected ToSanofi PharmaceuticalsNeedy Patient Programc/o Product Information Department90 Park AvenueNew York, NY 10016(800) 446-6267

Product(s) Covered By ProgramAralen,® Breonesin,® Danocrine,®

Drisdol®, Hytakerol,® Mytelase,®

NegGram,® pHisoHex,® Plaquenil,®

Primaquine.® Hyalgan,® Photofrin,®

Primacor,® and Skelid® eligibilitydetermined on a financial case-by-case basis.

Other Program InformationThe physician’s office should contactthe Sanofi Pharmaceuticals ProductInformation Department to apply onbehalf of a patient. An application issent to the physician’s office forcompletion and signature, in addition toa signed prescription. Upon receipt ofcompleted application and prescriptionfrom physician, and upon approval ofapplication, medication will be shippeddirectly to the physician’s office fromthe distribution center, inapproximately four to six weeks. Eachphysician is allowed to enroll sixpatients per year. Each patient canreceive a 3-month supply of medication,with an option of one refill for anadditional three months supply for atotal of six months medication for oneyear. The physician must contactSanofi’s office for the refill.

SCHERINGLABORATORIES/KEYPHARMACEUTICALSName Of ProgramCommitment to Care

Physician Requests Should BeDirected ToFor Intron A/Eulexin:(800) 521-7157

For Other Products:Schering Laboratories/Key PharmaceuticalsPatient Assistance ProgramP.O. Box 52122Phoenix, AZ 85072(800) 656-9485

Product(s) Covered By ProgramMost Schering/Key prescription drugs

EligibilityThe program is designed to assist thosepatients who are truly in need—indigent—who are not eligible forprivate or public insurance reimburse-ment and who cannot afford treatment.Patient eligibility is determined on acase-by-case basis based upon economicand insurance criteria. Eligibilitycriteria are currently being reevaluatedand may be subject to change.

Other Program InformationPhysician and patient complete anapplication form. Application isreviewed on a case-by-case basis.Repeat requests require a newapplication form to be completed.

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SEARLEName Of ProgramPatients in Need®

Physician Requests Should BeDirected ToAdministratorSearle Patients in Need® Foundation5200 Old Orchard RoadSkokie, IL 60077(800) 542-2526, (847) 581-6633 (fax)orLocal Searle Sales Representative

Product(s) Covered By ProgramAntihypertensives: Aldactazide®

(spironolactone withhydrochlorothiazide), Aldactone®

(spironolactone), Calan® SR (verapamilHCl) sustained-release, Kerlone®

(betaxolol HCl) Antihypertensive/Anti-Anginal/Anti-arrhythmic: Calan® (verapamil HCl),Covera-HS™ (verapamil HCl)Antiarrhythmics: Norpace® (disopyramidephosphate), Norpace® CR(disopyramide phosphate) extended-release Prevention of NSAID-induced gastric ulcers:Arthrotec® (diclofenacsodium/misoprostol), Celebrex™(celecoxib), Cytotec® (misoprostol)

EligibilityThe physician is the sole determinantof a patient’s eligibility for the programbased on medical and economic need.Searle provides guidelines forphysicians to consider, but they are notrequirements. Searle does not reviewdocumentation for eligibility. Theguidelines suggest that: patient suffersfrom conditions for which a Searleproduct in the Patients in Need®

program may be appropriate; patientdoes not qualify for outpatientprescription drugs under privateinsurance, a public program, or otherassistance that pays in whole or in partfor prescription drugs; patient’s incomefalls below a level suggested by Searle.

Other Program InformationPatients in Need® program certificatesfor free Searle medications are madeavailable to physicians. The physiciangives the patient the prescription for anappropriate Searle medication alongwith a certificate for the Patients inNeed® program. The patient then takesthe prescription and the certificate tothe pharmacy of his/her choosing, andthe pharmacist dispenses the prescrip-tion to the patient free of charge. Thepharmacist submits the certificate toSearle and is reimbursed by Searle.

SERONO LABORATORIES,INC.Name Of ProgramConnections for Growth

Physician Requests Should BeDirected ToJack DomieschelExecutive Director, CorporateCommunicationsSerono Laboratories, Inc.100 Longwater CircleNorwell, MA 02061(617) 982-9000, (617) 982-1369 (fax)

Product(s) Covered By ProgramSaizen® (somatropin [rDNA origin] forinjection) for treatment of pediatricgrowth hormone deficiency

• • •

Name Of ProgramSerono Laboratories’ Helping HandsProgram

Physician Requests Should BeDirected ToHelping Hands ProgramSerono Laboratories, Inc.100 Longwater CircleNorwell, MA 02061(617) 982-9000 ext. 5522, (617) 982-1369 (fax)

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Product(s) Covered By ProgramFertinex™ (urofollitropin for injection,purified), Gonal-F (follitropin alfa forinjection) for treatment of infertility

• • •

Name Of ProgramPatient Assistance Program

Physician Requests Should BeDirected ToJack DomieschelExecutive Director, CorporateCommunicationsSerono Laboratories, Inc.100 Longwater CircleNorwell, MA 02061(617) 982-9000, (617) 982-1369 (fax)

Product(s) Covered By ProgramSerostim™ (human growth hormone[rDNA origin]) for treatment of AIDSwasting

SIGMA-TAUPHARMACEUTICALS, INC.Name Of ProgramNORD/Sigma-Tau Carnitor®

Drug Assistance (CDA) Program

Physician Requests Should BeDirected ToCarnitor® Drug Assistance Programc/o NORDP.O. Box 8923New Fairfield, CT 06812-8923(800) 999-NORD

Product(s) Covered By ProgramCarnitor® (levocarnitine)

EligibilityAll applicants must be citizens orpermanent residents of the UnitedStates. Eligibility is determined bymedical and financial criteria and applied to a cost-share formula. A patient applying for eligibility under the CDA Program must firstdemonstrate having a legal prescription

for Carnitor®. Second, the applicantmust prove financial need above andbeyond the availability of federal andstate funds, private insurance or family resources.

If an applicant is a minor or an adultdependent, NORD may requestfinancial information of family membersor guardians before determining theapplicant’s eligibility.

Applications must be submittedannually to determine continuedmedical and financial eligibility.Acceptance into the program at anytime does not guarantee ongoingeligibility, nor does it mean thatapplicants are entitled to or will begranted benefits at a later time.

Other Program InformationGenerally, a patient over 18 years of agemay submit his or her own application.If the patient is an adult under theguardianship of another adult, or is aminor, the patient and his/her guardianor parents must jointly submit anapplication. Applications are reviewedthroughout the year. One applicationper patient, per year, will be accepted.In the event of a significant change in apatient’s circumstances, a secondapplication may be considered.

• • •

Name Of ProgramNORD/Sigma-Tau Matulane® PatientAssistance Program

Physician Requests Should beDirected ToMatulane® Patient Assistance Programc/o NORDP.O. Box 8923New Fairfield, CT 06812-8923(800) 999-NORD

Product(s) Covered By ProgramMatulane® (procarbazinehydrochloride)

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EligibilityAll applicants must be medicallyeligible for Matulane by having adiagnosis of Stage III or IV Hodgkin’sdisease documented by the treatingphysician, or any other lymphomaswhere a physician feels a response ispossible. All applicants must be a U.S.citizen or a permanent U.S. resident.All applicants must sign waivers andrelease of liability forms. The patient isresponsible for shipping and handlingcosts incurred. Applicants must provefinancial need above and beyond theavailability of federal and state funds,private insurance or family resources.

Other Program InformationOne application will cover the durationof the therapy regimen that isprescribed by the treating physician.This therapy is used in conjunctionwith certain other anticancer drugs forthe treatment of Stage III and IVHodgkin’s disease.

SMITHKLINE BEECHAMPHARMACEUTICALSName Of ProgramSB Access to Care Program

Physician Requests Should BeDirected ToAccess to Care ProgramSmithKline BeechamOne Franklin Plaza-FPl320Philadelphia, PA 19101(800) 546-0420

Product(s) Covered By ProgramMost SmithKline Beecham outpatientprescription products are covered.Controlled substances and vaccines arenot covered. Kytril, Hycamtin and Paxilare covered under separate Access toCare programs. (See listings.)

EligibilityPatient’s annual household income isless than $25,000. Patient has nomedical insurance and is ineligible forgovernment (e.g., Medicare) or privateprograms that cover the cost ofprescription pharmaceuticals. Patient isa resident of the United States.

Other Program Information Physicians are required to submit formsto enroll patients in the program.Product should be prescribed accordingto approved labeled indications anddosage regimens. All requests must bephysician initiated and be submitted onan original SB Access to Careapplication form. Photocopies of theapplication form are not acceptable.Both physician and patient must certifythat program guidelines are beingobserved. Quantity of product sent isdependent upon type of productprescribed. Reapplications are required.Product will be sent to the requestingphysician and receipt must be verifiedby signature. Third-party requests willnot be honored.

SB reserves the right to change programguidelines without notification.

• • •

Name Of ProgramOncology Access to Care Program

Physician Requests Should BeDirected ToThe Oncology Access to Care Hotline(800) 699-3806

Product(s) Covered By ProgramKytril (granisetron HCl) and Hycamtin(topotecan HCl)

• • •

Name Of ProgramAccess to Care Paxil CertificateProgram

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Physician Requests Should BeDirected ToAccess to Care Paxil Certificate Hotline(800) 729-4544

Product(s) Covered By ProgramPaxil® (paroxetine HCl)

SOLVAYPHARMACEUTICALS, INC.Name Of ProgramPatient Assistance Program

Physician Requests Should BeDirected ToSolvay Pharmaceuticals, Inc.c/o Phoenix Marketing GroupOne Phoenix DriveLincoln Park, NJ 07035(800) 788-9277

Product(s) Covered By ProgramCREON® 5 Capsules (Solvay 1205);CREON® 10 Capsules (Solvay 1210);CREON® Capsules (Solvay 1220);ESTRATAB® (esterified estrogenstablets, USP) 0.3 mg (Solvay 1014);ESTRATAB® (esterified estrogenstablets, USP) 0.625 mg (Solvay 1022);ESTRATEST® (esterified estrogensand methyltestosterone) Tablets(Solvay 1026); ESTRATEST® HS(esterified estrogens and methyl-testosterone) Tablets (Solvay 1023);LITHOBID® (lithium carbonate, USP)Tablets 300 mg (Solvay 4492);LUVOX® (fluvoxamine maleate)Tablets, 25 mg (Solvay 4202); LUVOX®

(fluvoxamine maleate) Tablets, 50 mg(Solvay 4205); LUVOX® (fluvoxaminemaleate) Tablets, 100 mg (Solvay4210); Advanced Formula ZENATE®

Prenatal Multivitamin/ MineralSupplement Tablets (Solvay 1148);PROMETIZIUM® Capsule SV;ROWASA® Enema (Solvay 1924);ROWASA® Suppository (Solvay 1928)

EligibilityThe patient’s eligibility is determinedon a case-by-case basis in consultationwith each prescribing physician and isbased on a patient’s inability to pay, lackof insurance, and ineligibility forMedicaid. The patient must be aresident of the United States. Thephysician is encouraged to waive his or her fee. The free product must beprovided to the patient for whom it is requested.

Other Program InformationPhysicians apply on behalf of the patientby submitting a written request on arequest form. Blank request forms canbe obtained by writing to SolvayPharmaceuticals, Inc., or by calling thePatient Assistance Program MessageCenter at (800) 788-9277. Ongoingpatient participation is available basedon continued medical and financialneed. The medication is sent directly to the physician, who provides it to the patient.

3M PHARMACEUTICALSName Of ProgramIndigent Patient PharmaceuticalProgram

Physician Requests Should BeDirected ToMedical Services Department275-2E-13, 3M CenterP.O. Box 33275St. Paul, MN 55133-3275(800) 328-0255, (651) 733-6068 (fax)

Product(s) Covered By ProgramMost drug products sold by 3MPharmaceuticals in the United States

EligibilityPatients whose financial and insurancecircumstances prevent them fromobtaining 3M Pharmaceuticals drugproducts considered to be necessary bytheir physicians. Consideration is on acase-by-case basis.

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WYETH-AYERSTLABORATORIESName Of ProgramNorplant Foundation

Physician Requests Should BeDirected ToThe Norplant FoundationP.O. Box 25223Alexandria, VA 22314(703) 706-5933

Product(s) Covered By ProgramThe Norplant® (levonorgestrelimplants) five-year contraceptivesystem

EligibilityDetermined on a case-by-case basis andlimited to individuals who cannot affordthe product and who are ineligible forcoverage under private and publicsector programs.

• • •

Name Of ProgramRheumatoid Arthritis AssistanceFoundation

Physician Requests Should BeDirected ToRheumatoid Arthritis AssistanceFoundationP.O. Box 766Washington, DC 20077-1207(800) 282-7704, (888) 508-8083 (fax)

Product(s) Covered By ProgramENBREL® (etanercept)

EligibilityTo qualify for assistance, patients orproviders should contact 1-800-282-7704 and staff will screen patients foreligibility over the phone. If the patientappears to qualify, an application will bemailed directly to the patient.Eligibility criteria are subject to changewithout notice.

Other Product InformationThe Rheumatoid Arthritis AssistanceFoundation was established to improveaccess to ENBREL® for patients whohave limited resources. To be eligiblefor assistance, patients must meet thecriteria set by the Foundation Board of Directors. Please call 1-800-282-7704for more information or to discusseligibility.

• • •

Name Of ProgramWyeth-Ayerst Laboratories IndigentPatient Program

Physician Requests Should BeDirected ToJohn E. JamesProfessional Services IPP31 Morehall RoadFrazer, PA 19355

Product(s) Covered By ProgramVarious products (not includingschedule II, III, or IV products)

EligibilityLimited to individuals, on a case-by-case basis, who have been identified bytheir physicians as “indigent,” meaning:a. Low or no incomeb. Not covered by any third-partyagency

Other Product InformationThe program is accessed by physicianswhose patients meet the eligibilityrequirements. A three-month supply ofspecific products is provided directly tothe physician for dispensing to thepatient. The patient’s signature isrequired on the application form.

ZENECAPHARMACEUTICALS (Please see AstraZeneca, p. 3)

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