Patient is not covered under any private prescription reimbursement plan. Patient is financially unable to pay for the product. Physician must complete and sign application.
Medication is shipped directly to physician's clinic.
Physician must write letter describing the necessity of the medication for treatment of the patient. The information on this website should not be used as a substitute for professional medical advice. You should contact your healthcare provider if you have any concerns or questions regarding your health condition. Information on this website should not be used to diagnose or treat a health problem or disease without consulting your healthcare provider.