Program Contact Info / Application Submission
Program	Fentora Reimbursement Program
Company	Cephalon, INC.
Address	PO Box 4280 Gaithersburg, MD 20885
Phone	877-433-6867
Fax	866-495-0657
Program Details
Details	Up to a 90-day supply is sent to the patient's home. The company automatically sends out refills. Once a year the application process must be repeated.
Program Requirements
Information	The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income.
Details	Proof of Income required
Delivery of Medication
Ship Time	approximately 1 week
Delivery Options	Can be delivered directly to the patient
Application Process
App Process	The patient or doctor needs to call for a prescreening. The application is sent to the doctor's office. The completed application must be faxed or mailed from the doctor's office. The doctor is notified of acceptance or denial.
Eligibility
Eligibility	The patient must have no prescription coverage for any medications and must be at or below the Federal Poverty Guidelines. The patient must be a US citizen or legal resident. If the patient is eligible for Medicare Part D but did not enroll, or is enrolled in Medicare Part D and is in the 'Donut Hole' then s/he is not eligible for this program. If the patient calls for the prescreening and qualifies for the program, the doctor must then call the company.