Patient Assistance Foundation Enrollment
The Novartis Patient Assistance Foundation, Inc. is committed to providing access to our medicines for those most in need. If you are experiencing financial hardship and have NO third-party insurance coverage for your medicines, you may be eligible to receive your Novartis medicines at no cost.
To be eligible, you must:
- Be a US resident
- Provide proof of income within program guidelines
- Not have private or public prescription coverage
Patient Assistance Program:
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline. You will be asked a few qualifying questions to determine your eligibility for the program, and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- Please be advised that access to the medicines distributed through the Novartis Patient Assistance Foundation, Inc. is free of charge to all eligible patients. Novartis is not affiliated with any individual or organization that may charge patients a fee(s) to assist them in completing applications for our program. These individuals or organizations are acting independently of the Novartis Patient Assistance Foundation, Inc. and its affiliates and do not have Novartis' consent.
- New Enrollment: To enroll in the Novartis PAP program select a product from the list below and follow the instructions provided:
Afinitor® (everolimus)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Afinitor Disperz® (everolimus suspension)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Alomide® (lodoxamide tromethamine solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Arcapta™ Neohaler™ (indacaterol inhalation powder)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Arranon® (nelarabine)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Arzerra® (ofatumumab)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Azopt® (brinzolamide suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Betoptic S® (betaxolol hydrochloride suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Bion® Tears
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Cipro® HC Otic (ciprofloxacin hydrochloride and hydrocortisone suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Ciprodex® (ciprofloxacin and dexamethasone)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Coartem® (artemether and lumefantrine)
Novartis Patient Assistance Program
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Cosentyx® (secukinumab)
PAP Enrollment Process
For patients who cannot afford the cost of Cosentyx® treatment and lack insurance, the Patient/Physician may call the Cosentyx® Connect Personal Support Program
1-844-267-3689 (844-COS-ENTY/X)
(8AM-9PM EST M-F)
Fax 1-844-666-1366
Cyclogyl® (cyclopentolate hydrochloride solution, USP)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Durezol® (difluprednate emulsion)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Emadine® (emedastine difumarate solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Entresto™ (sacubitril/valsartan)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Exjade® (deferasirox)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Extavia® (interferon beta-1b)
PAP Enrollment Process
For patients who cannot afford the cost of Extavia® treatment and lack insurance, the Patient/Physician may call the Extavia® Go Program at 1-866-925-2333.
Farydak® (panobinostat)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Flarex® (fluorometholone acetate suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Focalin® XR(dexmethylphenidate)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Gilenya® (fingolimod)
PAP Enrollment Process
For patients who cannot afford the cost of Gilenya® treatment and lack insurance, the Patient/Physician may call the Gilenya® Go Program at 1800-445-3692.
Glatopa™ (glatiramer acetate)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Gleevec® (imatinib mesylate)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Hycamtin® (topotecan) Capsules
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Hycamtin® (topotecan hydrochloride) For Injection
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Ilaris® (canakinumab)
PAP Enrollment Process
For patients who cannot afford the cost of Ilaris® treatment and lack insurance, the Patient/Physician may call the Ilaris Patient Support Program at 1-866-972-8315.
Ilevro® (nepafenac suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Jadenu ® (deferasirox)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Levoleucovorin Injection
PAP Enrollment Process
Novartis Patient Assistance Program
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Maxidex® (dexamethasone suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Mekinist® (trametinib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Myfortic® (mycophenolic acid)
PAP Enrollment Process
Novartis Patient Assistance Program
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Neoral® (cyclosporine soft gelatin capsule, USP)
PAP Enrollment Process
Novartis Patient Assistance Program
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Nevanac® (nepafenac suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Odomzo® (sonidegib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Omnitrope® Somatropin (rDNA origin)
For patients who cannot afford the cost of Omnitrope® treatment and lack insurance, the Patient/Physician may call the Patient Assistance Program at 1-800-277-2254 or visit the website below;
Pataday® (olopatadine hydrochloride solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Pazeo® (olopatadine hydrochloride solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Promacta® (eltrombopag)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Reclast® (zoledronic acid)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Sandimmune® (cyclosporine)
PAP Enrollment Process
Novartis Patient Assistance Program
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Sandostatin LAR® Depot (octreotide acetate)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Signifor® LAR (pasireotide)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualified individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Signifor® (Pasireotide)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Simbrinza® (brinzolamide/brimonidine tartrate suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Systane®
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Tafinlar® (dabrafenib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Tasigna® (nilotinib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Tegretol® (carbamazepine)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Tegretol-XR® (carbamazepine extended release)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Tobradex® Ophthalmic Ointment (tobramycin and dexamethasone ointment)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Tobradex® Ophthalmic Suspension (tobramycin and dexamethasone suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Tobradex® ST (tobramycin / dexamethasone suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
TOBI® (tobramycin inhalation solution USP)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
TOBI®Podhaler® (tobramycin inhalation)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Travatan Z® (travoprost solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Triesence® (triamcinolone acetonide injectable suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Trileptal® (oxcarbazepine)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Tykerb® (lapatinib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Tyzeka® (telbivudine)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
- You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts. You can request a faxed application by choosing the correct prompt and entering a fax number. Applications can be downloaded in a PDF format by following the links on the right hand side of this page.
- You will need to complete the upper portion of the application, and include your signature, the date and a copy of your most recent Federal Tax Return.
- Your physician should complete the lower portion of the enrollment application and attach a prescription for a three-month supply. Focalin® XR and Ritalin® LA are supplied through a pharmacy card.
- Qualifying individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, a 30 or 90-day supply of medication will be shipped directly to your physician. For Focalin® XR and Ritalin® LA, a pharmacy card will be issued.
- To obtain an additional 30 or 90-day supply of medication, a refill request form (included with each shipment) must be submitted along with a new prescription, or your physician can call 1-800-277-2254 to request a refill. For Focalin® XR and Ritalin® LA refills, you must obtain a prescription from your physician and take the prescription and your pharmacy card to a retail pharmacy for a refill.
Vexol® (rimexolone suspension)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Vigamox® (moxifloxacin hydrochloride solution)
PAP Enrollment Process
Novartis Patient Assistance Foundation
1-800-277-2254
Enrolling in the Novartis Patient Assistance Foundation is quick and easy.
Votrient® (pazopanib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Zarxio™ (filgrastim-sndz)
PAP Enrollment Process
For patients who cannot afford the cost of Zarxio™ treatment and lack insurance, the Patient/Physician may call the Sandoz One Source 1-844-726-3691 .
(9AM-8PM EST M-F)
Fax 1-844-726-3695
Zometa® (zoledronic acid for injection)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.
Zortress® (everolimus)
PAP Enrollment Process
Novartis Patient Assistance Program for Specialty Medicines
1-800-277-2254
Fax: 1-855-817-2711 (if the application is faxed it must be sent from the physician's office)
Enrolling in the Novartis Patient Assistance Program for Specialty Medicines is quick and easy.
- You can participate in a brief phone screening to help us understand your needs. You or your physician can call Novartis at 1-800-277-2254, selecting the appropriate phone prompts, or you can download the above application.
- You will need to complete all patient and physician sections of the attached application. You will need to attach an original prescription for the requested medication (refills may be included).
- Please attach a copy of your household's most recent year federal tax returns or financial documents.
- Please include your annual out-of-pocket medical expenses on the application.
- Mail or fax the application, prescription, and financial documentation to the address above.
Zykadia™ (ceritinib)
Oncology PAP Program Enrollment Process
Novartis Oncology Patient Assistance Program
PO Box 52029
PHOENIX, AZ 85072-2029
1-800-277-2254
Enrolling in the Novartis Oncology Patient Assistance is quick and easy.
** Please note for patients prescribed Exjade®, you or your physician should call EPASS Prescription and Reimbursement Hotline at 1-888-903-7277.
- To provide you with the best possible customer service, we recommend that you or your physician call our hotline.You will be asked a few qualifying questions to determine your eligibility for the program,and if found eligible you will be provided with a temporary supply of medication while you fill out the patient assistance program application.
- To get started,please call 1-800-277-2254 and select the appropriate phone prompts.
- If you [appear to] qualify for the patient assistance program based on this initial phone screening you will recieve, a temporary supply of medication and an application will be mailed directly to the patients home. Once received, you must complete the first four sections of the application, and include your signature, the date, a copy of your most recent Federal Tax Return, and a copy of your insurance card/prescription card, if applicable. Your physician must complete and sign the lower portion of the enrollment application.
- Alternatively you download a copy of the application from this site and fill it out and send to us directly at the above address, or fax it to us at 1-855-817-2711.Once received we will assess your full eligibility for the patient assistance program.
- Qualifyied individuals are eligible for up to one year of assistance, or until a prescription drug benefit becomes available to you. Upon approval, up to a year supply of medication will be shipped directly to you or your physician.