Drug:

 
Program Contact Info / Application Submission
Program BTA PAP
Company BIOVAIL
Address PO Box 836 Somerville, NJ 08876
Phone 866-268-7325
Fax 866-217-7164
 
Program Requirements
Details Insurance card NOT required
Drivers license NOT required
Proof of Income 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 NOT 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 NOT required as proof of income
 
Delivery of Medication
Ship Time 4-6 weeks
Delivery Options Can NOT 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
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 NOT apply for refills
Doctors can NOT apply for refills
Advocates can NOT apply for refills
Can NOT apply for refills via phone
Can NOT 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 NOT Re-Apply via fax
Can Re-Apply via mail
Appeals Income Appeals accepted on a case by case basis
Patients can NOT apply for Income Appeals
Doctors can apply for Income Appeals
Advocates can NOT 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 NOT apply for an appeal via fax
Can NOT apply for an appeal via mail
 
Appeals
Conditions Appeals will NOT consider out-of-pocket expenses
Appeals will NOT consider total medical expenses
Appeals may be made before the patient has been denied