rxhelp360.org
| Drug Information | |
| Drug | Elocon Cream 15g tube |
| Generic Equivalent | mometasone furoate |
| Topic | Skin |
| Program Contact Info / Application Submission | |
| Program | The Merck Patient Assistance Program |
| Company | Merck |
| Form | Download PDF |
| Address | PO Box 690, Horsham, PA 19044-9979 |
| Phone | 800-727-5400 |
| Website | http://www.merckpap.com |
| Program Requirements | |
| Details | Insurance card NOT required Drivers license NOT required Proof of Income NOT required |
| Delivery of Medication | |
| Ship Time | 2-3 weeks |
| Delivery Options | Can be delivered directly to the patient Can be delivered directly to the doctor |
| Application Process | |
| New Applications | New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can NOT apply for a new application via phone Can NOT apply for a new application via fax Can apply for a new application via mail |
| Refills | Refills accepted Patients can apply for refills Doctors can apply for refills Advocates can apply for refills Can apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail |
| Re-Applications | Re-Applications accepted Patients can apply for Re-Applications Doctors can apply for Re-Applications Advocates can apply for Re-Applications Can NOT Re-Apply via phone Can NOT Re-Apply via fax Can Re-Apply via mail |
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can NOT apply for an appeal via phone Can apply via fax Can NOT apply for an appeal via mail |
| Eligibility | |
| Limitations | Patients are eligible if LIS is denied Patients are NOT eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are eligible if they are accepting Medicare Patients are NOT eligible if they are accepting Medicare part D Patients are eligible if the medication is not covered under Medicare Patients are eligible if Medicare coverage has been exhausted |
| Appeals | |
| Conditions | Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals must be made after the patient has been denied |
| Other Medications | |
| Other Medications available in this program | |
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