Dr Edward S. Cooper, President of the American Health Association and
Professor of Medicine, University of Pehnsylvania, recommended that the Journal of the National Medical Association publish this list of pharmaceutical companies that are offering medications to indigent patients free of charge. This list appears as a Special Feature in the May/June 1992 issue of Heart Disease and Stroke, an American Heart Association journal. The JNMA expresses its appreciation to the American Health Association for allowing us to reprint "Cardiovascular Drulgs for the Medially Indigent." -The Editor
AReport to Primary Care Physicians on Pharmaceutical Companies' Service Recently an American Heart Association Task Force met to investigate the problems of access to health care in the United States, particularly drugs for the medically indigent. The task force fbund that many pharmaceutical companies offered drugs to the indigent at little or no cost. Following is a list of the companies, the cardiovasculVar drugs available, how these drugs can be obtained, and eligibility requirements. This list is not all inclusive; as more information becomes available, we will share it with you in future editions of Heart Disease and Stroke.
Company and Cardiovascular Products
Who Is Eligible/How Products Are Obtaed
Bristol-Myers Squibb All 17 cardiovascular products, such as Betapen Capoten Capozide
Patients obtain an 800 number from their physician and call the reimbursement counselor to determine if they are eligible. If a patient is ineligible for Medicaid or other third-party reimbursement programs but in need of assistance, the counselor will send an application to the patient's physician. The physician and patiet: complete and sign the form, attach a prescription, and rturn the form to the counselor. After eligibility is determi'ned, a 90-day sily will be sent to the patient's physician. A counselor will follow Up each case. When the 90-day supply is nearly depleted, the physician will receive a letter asking for certification that the patient's financial status has not changed and that the patient needs the drugs for another 90 days. After 180 days the patient must requalify Contact:.X 1-800-736-0003. continued on page 1066
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL, 84, NO. 12
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CRITICAL VIEWS & NEWS
continued from page 1003
CIBA-GEIGY All cardiovascular products
G.D. Searle & Company Eight cardiovascular drugs, including Calan Kerlone Nitrodisc Genentech Activase
Glaxo Trandate
Hoechst-Roussel Pharmaceuticals Lasix Altace
ICI Pharmaceuticals Group Tenormin Zestril Knoll Pharmaceuticals Isoptin Rythmol
1 066
Available to outpatients who are ineligible for third-party reimbursement for prescription drugs and deemed indigent by their physician. An application that contains the physician's signature, DEA number, and a prescription for a 3-month supply of the product is submitted by the physician. The drug supply is sent by United Parcel Service to the physician for dispensing to the patient. A completed application and prescription are required for each 3-month supply. Contact: 908-277-5849. Drugs are provided free to anyone who is uninsured. Requests are made by the patient's physician. The patient is given a certificate that can be redeemed at any pharmacy. Searle reimburses the pharmacist through the company's "Patients in Need Program." Contact: 1-800-542-2526. A patient must have an annual family gross income of less than $25 000. Patients cannot be eligible for or receiving Medicaid, Medicare, county or state assistance programs, or have private insurance coverage. The hospital completes a qualification form and provides documentation to verify the patient's annual family gross income, the diagnosis, and dosage of Activase. Replacement vials are shipped to the hospital pharmacy within 30 days of receipt of all required documentation. Contact: 1-800-879-4747.
Exclusively for private outpatients who are considered medically indigent by the physician and who are ineligible for any other third-party drug reimbursement program. Additionally, for a patient to be considered indigent and eligible for this program, the physician must waive fees for the patient. The physician must complete an application requiring the physician's signature and DEA number. Contact: 1-800-GLAXO77. Case-by-case basis. This policy covers patients who are ineligible for Medicaid or other third-party reimbursement. Upon receipt of the physician's prescription and a letter certifying that the patient is medically indigent, Hoechst-Roussel provides the product without charge to a pharmacy for dispensing to the patient. Contact: 1-800-445-4774. Requests are made through an application process that involves both the physician and the patient. Contact: 302-886-2231. Knoll distributes medication to the medically indigent in three ways: 1) free samples are given to physicians, who pass them along to patients; 2) physicians request a package of free medication from Knoll by completing a form or writing a prescription (prescription drugs take 3 to 4 weeks; Knoll limits each physician's request to two per month); and 3) patients obtain a certificate from their physician and take it to a pharmacist to receive 30 free tablets. Contact: 1-800-524-2474.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
CRITICAL VIEWS & NEWS
Lederle Laboratories Maxzide ProStep Verelan
Case-by-case basis. Program involves the pharmaceutical representative, the physician, and the patient. The physician completes and signs a form declaring the patient medically indigent. The patient is then entered into Lederle's "Patient Assistance Program." Contact: 1-800-533-3753.
3M Pharmaceuticals Tambocor Minitran Marion Merrell Dow All cardiovascular prescription products
Case-by-case basis. A confirmation of need from the physician or social worker is required. Contact: 1-800-328-0255.
McNeil Pharmaceuticals Vascor
Merck Sharp & Dohme All cardiovascular drugs except injectable medicines
Miles Inc Pharmaceutical Division Adalat Nimotop
Pfizer All Pfizer cardiovascular drugs, including Cardura Procardia Procardia XL
Roche Laboratories, Division of Hoffmann-La Roche Inc; Roche Products Inc All cardiovascular drugs, including Bumex Valium
Case-by-case basis. The physician makes a request to the company. A program description is then sent to the physician. The physician completes the paperwork regarding the medically indigent patient and returns it to Marion Merrell Dow. The drug is then sent to the physician for the patient. Marion Merrell Dow is in the process of enhancing its program. Contact: 816-966-4000.
Case-by-case basis. Program requires a signed and dated prescription that includes the physician's professional designation, the state license or federal DEA number, and a brief statement affirming that the patient is medically indigent. The product is sent to the physician. Contact (call collect): 215-628-5297. Physician sends a written request with a brief statement of the patient's medical need, financial hardship, and absence of insurance eligibility. A signed and dated prescription with professional designation and state license or DEA number must be included. The physician's prescription determines the amount of medicine, not to exceed a 3-month supply, which is shipped to the physician. Contact: 215-540-8600. The patient must complete an application form and certify that the information is correct. Once the application is approved, the product is sent to the physician. Contact: Kevin Higgins, MD, 1-800-4680894. Under the "Pfizer Indigent Program," physicians providing uncompensated care to medically indigent patients can write to the company advising them that the patient's prescription is not being reimbursed by Medicaid or a third-party insurance program. The company will then supply the medication to the physician at no charge, provided a prescription for the product is enclosed. Contact: 212-573-3954. Available to outpatients who are ineligible for a third-party reimbursement program. Inpatients and those who can obtain drug reimbursement from other sources are ineligible. An application must be completed with the physician's signature and DEA number. The company will ship up to a 3-month supply to the physician; delivery usually takes 2 to 3 weeks. A repeat request does not require a full application, only the patient's initials or chart number, the drug, and dosage. Contact: 1-800-526-6367.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
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CRITICAL VIEWS & NEWS
Sandoz Pharmaceuticals Sandimmune
Administered by the National Organization for Rare Disorders (NORD), the "NORD/Sandoz Drug Cost Share Program" is a source for patients whose federal, state, or private insurance funds and other resources do not cover the costs for the identified products. Generally, patients or guardians submit their own application to NORD. Eligibility is determined by medical and financial criteria and applied to a cost-share formula. Contact: 1-800-447-NORD.
SmithKline Beecham Dyazide
Case-by-case basis. For the "Indigent Patient Program," a physician contacts a sales representative, who delivers the product (up to a 3-month supply) to the physician. Patients are not required to submit any forms to be enrolled in this program; however, the physician should send a letter confirming patient need and eligibility. Contact: 215-751-5760. To be eligible for the "Compassionate Care Program," the patient must demonstrate that he or she does not have insurance. Single patients must have an income of $18 000 or less; married patients or patients with at least one dependent must have an income of $25 000 or less. The hospital should submit a hospital consent form, an application form, and a copy of the patient's clinical record. The drug will be shipped to the hospital within 30 days after the application has been approved. Contact: 1-800-866-6273.
Eminase
Wyeth-Ayerst Various cardiovascular drugs
1 068
Case-by-case basis. This program requires a signed and dated prescription that includes the physician's professional designation, the state license or federal DEA number, and a brief statement affirming that the patient is medically indigent and has no form of coverage for pharmaceutical products. The product is sent to the physician. Contact: 215-971-5604.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
Professor of Medicine, University of Pehnsylvania, recommended that the Journal of the National Medical Association publish this list of pharmaceutical companies that are offering medications to indigent patients free of charge. This list appears as a Special Feature in the May/June 1992 issue of Heart Disease and Stroke, an American Heart Association journal. The JNMA expresses its appreciation to the American Health Association for allowing us to reprint "Cardiovascular Drulgs for the Medially Indigent." -The Editor
AReport to Primary Care Physicians on Pharmaceutical Companies' Service Recently an American Heart Association Task Force met to investigate the problems of access to health care in the United States, particularly drugs for the medically indigent. The task force fbund that many pharmaceutical companies offered drugs to the indigent at little or no cost. Following is a list of the companies, the cardiovasculVar drugs available, how these drugs can be obtained, and eligibility requirements. This list is not all inclusive; as more information becomes available, we will share it with you in future editions of Heart Disease and Stroke.
Company and Cardiovascular Products
Who Is Eligible/How Products Are Obtaed
Bristol-Myers Squibb All 17 cardiovascular products, such as Betapen Capoten Capozide
Patients obtain an 800 number from their physician and call the reimbursement counselor to determine if they are eligible. If a patient is ineligible for Medicaid or other third-party reimbursement programs but in need of assistance, the counselor will send an application to the patient's physician. The physician and patiet: complete and sign the form, attach a prescription, and rturn the form to the counselor. After eligibility is determi'ned, a 90-day sily will be sent to the patient's physician. A counselor will follow Up each case. When the 90-day supply is nearly depleted, the physician will receive a letter asking for certification that the patient's financial status has not changed and that the patient needs the drugs for another 90 days. After 180 days the patient must requalify Contact:.X 1-800-736-0003. continued on page 1066
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL, 84, NO. 12
0 0;10l03 00 :00 Si::
C:XS~ ~ ~ ~
CRITICAL VIEWS & NEWS
continued from page 1003
CIBA-GEIGY All cardiovascular products
G.D. Searle & Company Eight cardiovascular drugs, including Calan Kerlone Nitrodisc Genentech Activase
Glaxo Trandate
Hoechst-Roussel Pharmaceuticals Lasix Altace
ICI Pharmaceuticals Group Tenormin Zestril Knoll Pharmaceuticals Isoptin Rythmol
1 066
Available to outpatients who are ineligible for third-party reimbursement for prescription drugs and deemed indigent by their physician. An application that contains the physician's signature, DEA number, and a prescription for a 3-month supply of the product is submitted by the physician. The drug supply is sent by United Parcel Service to the physician for dispensing to the patient. A completed application and prescription are required for each 3-month supply. Contact: 908-277-5849. Drugs are provided free to anyone who is uninsured. Requests are made by the patient's physician. The patient is given a certificate that can be redeemed at any pharmacy. Searle reimburses the pharmacist through the company's "Patients in Need Program." Contact: 1-800-542-2526. A patient must have an annual family gross income of less than $25 000. Patients cannot be eligible for or receiving Medicaid, Medicare, county or state assistance programs, or have private insurance coverage. The hospital completes a qualification form and provides documentation to verify the patient's annual family gross income, the diagnosis, and dosage of Activase. Replacement vials are shipped to the hospital pharmacy within 30 days of receipt of all required documentation. Contact: 1-800-879-4747.
Exclusively for private outpatients who are considered medically indigent by the physician and who are ineligible for any other third-party drug reimbursement program. Additionally, for a patient to be considered indigent and eligible for this program, the physician must waive fees for the patient. The physician must complete an application requiring the physician's signature and DEA number. Contact: 1-800-GLAXO77. Case-by-case basis. This policy covers patients who are ineligible for Medicaid or other third-party reimbursement. Upon receipt of the physician's prescription and a letter certifying that the patient is medically indigent, Hoechst-Roussel provides the product without charge to a pharmacy for dispensing to the patient. Contact: 1-800-445-4774. Requests are made through an application process that involves both the physician and the patient. Contact: 302-886-2231. Knoll distributes medication to the medically indigent in three ways: 1) free samples are given to physicians, who pass them along to patients; 2) physicians request a package of free medication from Knoll by completing a form or writing a prescription (prescription drugs take 3 to 4 weeks; Knoll limits each physician's request to two per month); and 3) patients obtain a certificate from their physician and take it to a pharmacist to receive 30 free tablets. Contact: 1-800-524-2474.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
CRITICAL VIEWS & NEWS
Lederle Laboratories Maxzide ProStep Verelan
Case-by-case basis. Program involves the pharmaceutical representative, the physician, and the patient. The physician completes and signs a form declaring the patient medically indigent. The patient is then entered into Lederle's "Patient Assistance Program." Contact: 1-800-533-3753.
3M Pharmaceuticals Tambocor Minitran Marion Merrell Dow All cardiovascular prescription products
Case-by-case basis. A confirmation of need from the physician or social worker is required. Contact: 1-800-328-0255.
McNeil Pharmaceuticals Vascor
Merck Sharp & Dohme All cardiovascular drugs except injectable medicines
Miles Inc Pharmaceutical Division Adalat Nimotop
Pfizer All Pfizer cardiovascular drugs, including Cardura Procardia Procardia XL
Roche Laboratories, Division of Hoffmann-La Roche Inc; Roche Products Inc All cardiovascular drugs, including Bumex Valium
Case-by-case basis. The physician makes a request to the company. A program description is then sent to the physician. The physician completes the paperwork regarding the medically indigent patient and returns it to Marion Merrell Dow. The drug is then sent to the physician for the patient. Marion Merrell Dow is in the process of enhancing its program. Contact: 816-966-4000.
Case-by-case basis. Program requires a signed and dated prescription that includes the physician's professional designation, the state license or federal DEA number, and a brief statement affirming that the patient is medically indigent. The product is sent to the physician. Contact (call collect): 215-628-5297. Physician sends a written request with a brief statement of the patient's medical need, financial hardship, and absence of insurance eligibility. A signed and dated prescription with professional designation and state license or DEA number must be included. The physician's prescription determines the amount of medicine, not to exceed a 3-month supply, which is shipped to the physician. Contact: 215-540-8600. The patient must complete an application form and certify that the information is correct. Once the application is approved, the product is sent to the physician. Contact: Kevin Higgins, MD, 1-800-4680894. Under the "Pfizer Indigent Program," physicians providing uncompensated care to medically indigent patients can write to the company advising them that the patient's prescription is not being reimbursed by Medicaid or a third-party insurance program. The company will then supply the medication to the physician at no charge, provided a prescription for the product is enclosed. Contact: 212-573-3954. Available to outpatients who are ineligible for a third-party reimbursement program. Inpatients and those who can obtain drug reimbursement from other sources are ineligible. An application must be completed with the physician's signature and DEA number. The company will ship up to a 3-month supply to the physician; delivery usually takes 2 to 3 weeks. A repeat request does not require a full application, only the patient's initials or chart number, the drug, and dosage. Contact: 1-800-526-6367.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
1 067
CRITICAL VIEWS & NEWS
Sandoz Pharmaceuticals Sandimmune
Administered by the National Organization for Rare Disorders (NORD), the "NORD/Sandoz Drug Cost Share Program" is a source for patients whose federal, state, or private insurance funds and other resources do not cover the costs for the identified products. Generally, patients or guardians submit their own application to NORD. Eligibility is determined by medical and financial criteria and applied to a cost-share formula. Contact: 1-800-447-NORD.
SmithKline Beecham Dyazide
Case-by-case basis. For the "Indigent Patient Program," a physician contacts a sales representative, who delivers the product (up to a 3-month supply) to the physician. Patients are not required to submit any forms to be enrolled in this program; however, the physician should send a letter confirming patient need and eligibility. Contact: 215-751-5760. To be eligible for the "Compassionate Care Program," the patient must demonstrate that he or she does not have insurance. Single patients must have an income of $18 000 or less; married patients or patients with at least one dependent must have an income of $25 000 or less. The hospital should submit a hospital consent form, an application form, and a copy of the patient's clinical record. The drug will be shipped to the hospital within 30 days after the application has been approved. Contact: 1-800-866-6273.
Eminase
Wyeth-Ayerst Various cardiovascular drugs
1 068
Case-by-case basis. This program requires a signed and dated prescription that includes the physician's professional designation, the state license or federal DEA number, and a brief statement affirming that the patient is medically indigent and has no form of coverage for pharmaceutical products. The product is sent to the physician. Contact: 215-971-5604.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 12
