rxhelp360.org
| Drug Information | ||||||||||||||||
| Drug | Macrodantin | |||||||||||||||
| Generic Equivalent | nitrofurantoin macrocrystals | |||||||||||||||
| Topic | Antibiotic | |||||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||||
| Program | Procter & Gamble Pharmaceuticals Patient Assistance Program | |||||||||||||||
| Company | Proctor | |||||||||||||||
| Form | Download PDF | |||||||||||||||
| Address | c/o Express Scripts, PO Box 66553, St. Louis MO 63166-66553 | |||||||||||||||
| Phone | 800-830-9049 | |||||||||||||||
| Fax | 866-277-9329 | |||||||||||||||
| Website | http://www.pg.com/product_card/prod_card_rx_drugs.jhtml | |||||||||||||||
| Program Details | ||||||||||||||||
| Details | Up to a 90-day supply is shipped to either the doctor�s office or the patient�s home. For refills, the patient or doctor must contact the company directly. A new application is needed once a year. | |||||||||||||||
| Program Requirements | ||||||||||||||||
| Information | The doctor fills out their section, signs the application and attaches a prescription for a 90-day supply. The patient must also fill out their section, sign the application and attach proof of income. | |||||||||||||||
| Details | Insurance card will be considered on a case by case basis Drivers license required Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero income required as proof of income Form 4506T (If taxes were not filed) NOT required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy required as proof of income Letter from employer required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income required as proof of income | |||||||||||||||
| Delivery of Medication | ||||||||||||||||
| Ship Time | 2-3 weeks | |||||||||||||||
| Delivery Options | Can NOT be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card | |||||||||||||||
| Application Process | ||||||||||||||||
| App Process | With the patient�s permission, anyone can call and request an application. Completed applications can be mailed back or faxed from the doctor�s office. Both the patient and doctor are notified in writing of eligibility into the program. Decisions are usually made within 2 weeks and the medication is shipped out within 5-7 business days thereafter. | |||||||||||||||
| 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 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 apply for refills via fax Can 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 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 accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can apply via fax Can apply for an appeal via mail | |||||||||||||||
| Eligibility | ||||||||||||||||
| Eligibility | The patient must have no prescription coverage for any medication being requested and meet income guidelines that are not disclosed. If the patient is eligible for Medicare Part D but did not enroll they must first be apply for and be denied for the Low Income Subsidy through Social Security. | |||||||||||||||
| Limitations | Patients are eligible if LIS is denied Patients may be eligible with existing prescription coverage on a case by case basis Patients may be eligible if prescription is not covered on a case by case basis Patients may be eligible if prescription coverage has been exhausted on a case by case basis Patients are eligible if they are accepting Medicare Patients are NOT eligible if they are accepting Medicare part D Patients may be eligible if the medication is not covered under Medicare on a case by case basis Patients may be eligible if Medicare coverage has been exhausted on a case by case basis | |||||||||||||||
| Appeals | ||||||||||||||||
| Conditions | Appeals will consider out-of-pocket expenses Appeals will 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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