Program Contact Info / Application Submission
Program	Wyeth Patient Assistance Program
Company	Wyeth
Address	PO Box 66762, St Louis, MO 63166-6762
Phone	866-706-2400
Website	http://www.wyeth.com/contact?rid=/wyeth_html/home/shared/footer/Patient/contact_patient_assist.html
Program Requirements
Details	Insurance card required Drivers license 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
Delivery of Medication
Ship Time	5-10 days
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 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 NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT 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 apply for an appeal via phone Can apply via fax Can NOT apply for an appeal via mail
Eligibility
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are NOT eligible if prescription is not covered Patients are NOT eligible if prescription coverage has been exhausted Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are NOT eligible if the medication is not covered under Medicare Patients are NOT 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 may be made before the patient has been denied