FOSRENOL^® | at hand — How can it help?

FOSRENOL^® | at hand is designed to provide assistance to patients taking FOSRENOL^®.

To find out how this program can help you, call the toll-free hotline at
1-866-470-5858 to speak with a trained representative who can answer your questions and help you enroll in the FOSRENOL^® | at hand program.

In addition, representatives can help you.

• Contact your insurer to determine benefits
• Provide information about insurers’ coverage policies
• Explain ways to expedite reimbursement, including prior authorization procedures
• Assist with resolving any denied claims and with appeals

If you don’t feel comfortable calling the hotline, please speak with your healthcare professional. He or she should be able to answer your questions regarding this program and help you enroll.

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Who is eligible for assistance?

FOSRENOL^® | at hand program has been designed to help provide access to FOSRENOL^® for patients who are in need of assistance. Patients may be eligible under one of the following:

*In the event a Medicare Part D enrolled patient is approved, they will be provided product in monthly quantities only up to the end of the calendar year. For example, if your patient is approved in November, he or she will receive a 60-day supply of FOSRENOL^®.

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How much assistance is available?

Depending on your personal circumstance, the FOSRENOL^® | at hand program can provide medication either free or at a shared (reduced) cost. The amount of assistance provided will vary depending on your level of prescription drug coverage and financial need.

The table below lists the measures for whether FOSRENOL^® can be made available to you at no cost or at a shared cost.

Through FOSRENOL^® | at hand you will receive FOSRENOL^® (either free or at shared cost) in monthly quantities up to the end of the calendar year. For example, if you are approved in November, you will receive a 60-day supply of FOSRENOL^®.

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How do I apply for assistance?

Download, print and complete the FOSRENOL^® | at hand online application form (PDF) — this is the only application to be filled out regardless of your level of need or situation. To ensure a prompt response, please complete the application in its entirety.

• Remember to sign the Patient Statement Section
• Have your healthcare provider sign the Practitioner Statement Section
• Attach proof of ALL household income (most recent federal tax return 1040, Social Security SSA 1099, pensions, interest, stocks, and information regarding other assets)
• Attach your FOSRENOL^® prescription
• Check box to indicate where shipment should be delivered (no P.O. boxes)
• Complete all insurance information (if applicable)
• Complete the allergy information section
• Send your completed application to:
  

  FOSRENOL^® | at hand Patient Assistance Program,
  P.O. Box 1057, Somerville, NJ 08876

• All forms can also be faxed to 866-470-5860, but an original prescription must be mailed to the address above to fully process a patient's application.

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In order to view PDF documents, you must have Adobe^® Reader^® installed on your computer. If you do not have it, you may download it from the Adobe website.