Patient Assistance Program
If patients need help determining your health care coverage benefits or need assistance regarding FOSRENOL®, instruct them to call toll free 1-866-470-5858.
Click Here to Download the FOSRENOL® | at Hand Online Application Form (PDF) to Give to Your Patients
- FOSRENOL® | at Hand—How can it help?
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FOSRENOL® | at Hand is designed to provide assistance to patients taking FOSRENOL®. To find out how this program can help your patients, instruct them to call the toll-free hotline at 1-866-470-5858 to speak with a trained representative who can answer their questions and help them enroll in the FOSRENOL® | at Hand program.
In addition, representatives can help your patients:
- Contact their 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
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- Who is eligible for assistance?
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The FOSRENOL® | at Hand program has been designed to provide access to FOSRENOL® for patients who are in need of assistance. Patients may be eligible under one of the following:
Patient Assistance Program
- Patients in financial need who have no coverage for FOSRENOL® under prescription drug benefits, Medicare, Medicaid, or other state-funded programs. Patients falling into this category may receive FOSRENOL® free of charge or at a shared (reduced) cost.
Or
Medicare Part D
- Patients who are enrolled in a Medicare Part D program but cannot afford their co-payments or co-insurance or are facing a gap in coverage known as the “donut hole,” a period of time when patients are not receiving prescription drug benefits, within their respective plans. For patients who qualify for assistance in this category, FOSRENOL® will be made available free of charge.*
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- How much assistance is available?
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Depending on the personal circumstances of your patients, 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 your patients at no cost or at a shared cost.
Through FOSRENOL® | at Hand your patients will receive FOSRENOL® (either free or at shared cost) in monthly quantities 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 do my patients apply for assistance?
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You can download and print a FOSRENOL® | at Hand online application form (PDF) for your patients to complete. This is the only application to be filled out regardless of your patients' level of need or situation. To ensure a prompt response, patients must complete the application in its entirety They should:
- Remember to sign the Patient Statement Section
- Have their health care 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 their FOSRENOL® prescription
- Check box to indicate where shipment should be delivered (no PO boxes)
- Complete all insurance information (if applicable)
- Complete the allergy information section
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Send their completed application to:
FOSRENOL® | at Hand Patient Assistance Program,
PO Box 1057, Somerville, NJ 08876
- All forms can also be faxed to 866-470-5860, but original prescriptions must be mailed to the address above to fully process patients' applications.
Applications for FOSRENOL® | at Hand are accepted on an ongoing basis.
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