| Pharmaceutical Company | Sanofi Pharmaceuticals, Inc. |
| Program Address | Sanofi Pharmaceuticals, Inc. Needy Patient Program Product Information Dept., 7th Floor 90 Park Ave. New York, NY 10016 |
| Toll Free Phone Number | 800-446-6267 |
| Fax Number | 212-551-4902 |
| Guidelines and Notes | This program has VERY stringent guidelines. If you qualify for this program, you may very well qualify for a state program, if you live in a state where one is available! And in order to get help, you must NOT be eligible for other programs, so you need to check this out first. If you don't qualify for any other programs, your household income must be less than 125% of the federal poverty level. That is, for a houshold of (1) $11,075; (2) $14,925; (3) $18,775; (4) 22,625; (5) 26,475; (6) 30,325. Also, patient can't be eligible for any other financial help with prescriptions. Each doctor can have ONLY SIX PTS. A YEAR on the program. Be sure to put patient's Social Security number on the form. |
| Initiating Enrollment | Call for form which they will fax. |
| Health Provider's Role | Doctor completes, signs, and ATTACHES RX. OK for nurse practitioner or physician's assistant (with Rx privileges) to sign prescription, but needs to put a physician's name on application. Application must be mailed (not faxed) |
| Patient's Role | Patient signature not required. Minimal information required, would be on-file already. |
| How Dispensed | Sends medicine to doctor's office -- provide street address, NOT PO BOX!! |
| Amount Dispensed | 3 month supply. |
| Refills | Can only get medication for 6 months in a year, so must be off program for 6 months to be eligible to re-apply. |
| Limit | Indefinitely -- but only 6 months each year sent as two-ninety day supplies |