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| Drug Information |
| Drug | Hexalen 50mg | | Generic Equivalent | altretamine | | Class | antineoplastic | | Topic | Cancer | | |
| Program Contact Info / Application Submission |
| Program | MGI Pharma Patient Assistance Program | | Company | EISAI Inc | | Form | Download PDF | | Address | PO Box 4133 Gaithersburg, MD 20885-4133 | | Phone | 877-644-6270 | | Fax | 888-644-7236 | | |
| Program Details |
| Details | The medication is sent to the doctor's office. The doctor/doctor's office must contact the company to arrange refills. Every year a new application is needed.
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| Program Requirements |
| Information | The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
| | Details | Proof of Income required
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| Delivery of Medication |
| Ship Time | 24-72 Hours | | Delivery Options | Can be delivered directly to the doctor
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| Application Process |
| App Process | Anyone can write the company to request an application. The application is faxed to the doctor's office. The completed application can be faxed or mailed back. Both the patient and doctor are notified of acceptance into the program. The medication is shipped within 2 business days.
| | Refills | Doctors can apply for refills
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| Eligibility |
| Eligibility | The patient must not have any private nor public insurance and meet income guidelines that are not disclosed. There is an insurance verification for patients with insurance. If a patience has insurance and the medication is not covered, then they may still be eligible for this program. Up to four bottles of Aloxi is sent out in one month, up to eight bottles of Hexalen are sent out every two months.
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| Other Medications |
Other
Medications
available in
this program | |
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