| Pharmaceutical Company | Bayer Pharmaceuticals |
| Program Address | Bayer Patient Assistance Program PO Box 29209 Phoenix, AZ 85038-9209 |
| Toll Free Phone Number | 800-998-9180 |
| Fax Number | 602-808-7010 |
| Guidelines and Notes | Patient must be close to poverty to meet guidelines, but if there are extenuating circumstances, apply anyway. Call between 9-5 eastern standard time. |
| Initiating Enrollment | Anyone can call. They take most information over the phone and then send application to the doctor. Group number, ID number and a process number are given to caller so patient can bring them to pharmacy with prescription to first 30 days, then application is sent to doctor. |
| Health Provider's Role | Call in patient information including financial and monthly medical expenses. Doctor signs and dates form and sends. Company authorizes additional use of card (beyond 30 days) once form is received. |
| Patient's Role | Detailed financial and insurance information needed. Complete patient section of form and sign it. Advise physician of any changes in household income or insurance coverage. |
| How Dispensed | Sends card with application for patient to bring to pharmacy that participates in RECAP program with RX. |
| Amount Dispensed | Each application is good for up to another 5 monhths. Then another application is sent before that expires, that will cover an additional 6 months. |
| Refills | New application needed twice a year.. |
| Limit | Indefinitely |