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Participation
Physicians apply on behalf of the patient by submitting a completed application form. Blank forms may be obtained by calling (800) 256-8918, or forms can be printed below. Ongoing patient participation is available based on continued medical and financial need.
Eligibility
The patient must be a legal U.S. resident, and the patient’s household income must fit within certain financial criteria. This is determined by comparing the patient’s annual household income to an equation based upon poverty guidelines established by the federal government. The patient must have a valid prescription for an available product of Solvay Pharmaceuticals, Inc. or its subsidiary, Unimed Pharmaceuticals, Inc. Other eligibility criteria may apply, and program terms and conditions are subject to change without notification.
Products Covered (subject to change)
ACEON® (perindopril erbumine) Tablets 2 mg, 4 mg and 8 mg
*AndroGel® (testosterone gel) 1% CIII
CREON® MINIMICROSPHERES® (pancrelipase delayed-release capsules, USP) 5, 10 and 20
ESTRATEST® (esterified estrogens, USP 1.25 mg and methyltestosterone, 2.5 mg) Tablets
ESTRATEST® H.S. (esterified estrogens, USP 0.625 mg and methyltestosterone, 1.25 mg) Tablets
*MARINOL® (dronabinol) CIII Capsules
PROMETRIUM® (progesterone, USP) 100 mg and 200 mg Capsules
*A Unimed Pharmaceuticals product
TRICOR®
Assistance for TRICOR® (fenofibrate) is available for patients who qualify through the Abbott Laboratories Patient Assistance Program:
Abbott Laboratories Patient Assistance Program
Pharmaceutical Products Division
Dept D-31C, J23
200 Abbott Park Rd.
Abbott Park, IL 60064
Phone: 1-800-222-6885
Please note that program rules and guidelines at Wyeth Pharmaceuticals and Abbott Laboratories may differ from those in place for the Solvay Pharmaceuticals, Inc. Patient Assistance Program.
Application Form
Click here to view and print the Patient Assistance Program enrollment application form.
Patient Hotline
1-800-256-8918
Physician Requests
Physician requests relating to the Solvay Pharmaceuticals Inc. Patient Assistance Program should be sent to the administrator of the program at the address below:
Solvay Pharmaceuticals, Inc. Patient Assistance Program
P.O. Box 66550
St. Louis, MO 63166-6650
Fax: 1-800-276-9901
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