Sculptra Patient Access Program
Sanofi-Aventis
The sanofi-aventis Sculptra Patient Access Program is designed to help the uninsured and people in need better afford their prescription medicines, subject to financial restrictions.
Contact Information
Sculptra Patient Access Program
PO BOX 430
Somerville, NJ 08876
1-(800) 221-4025 (phone)
1-(866) 734-7372 (fax)
Sculptra Patient Access Program
PO BOX 430
Somerville, NJ 08876
1-(800) 221-4025 (phone)
1-(866) 734-7372 (fax)
Physician requests should be directed to:
1-(866) 310-7551 (phone)
1-(866) 310-7551 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
Patient must be a legal resident of the United States. Patient cannot have or qualify for state or federal reimbursement for Sculptra. Patient cannot have private insurance reimbursement for Sculptra- Practitioner must acknowledge receipt of materials regarding product administration. Practitioner must confirm that Sculptra™ will be used consistent with the FDA approved indication of restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. Patient's total annual household income must be within an income level based on total household income and dependents. Please contact the program for more specifics.
Patient must be a legal resident of the United States. Patient cannot have or qualify for state or federal reimbursement for Sculptra. Patient cannot have private insurance reimbursement for Sculptra- Practitioner must acknowledge receipt of materials regarding product administration. Practitioner must confirm that Sculptra™ will be used consistent with the FDA approved indication of restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. Patient's total annual household income must be within an income level based on total household income and dependents. Please contact the program for more specifics.
Other Information:
The Patient or Advocate should contact the Hotline to apply on behalf of a patient. An application is sent to the caller for completion and signature by both the Patient and Doctor, in addition to a signed prescription. Upon receipt of completed application, prescription from physician, and approval of application, medication will be shipped directly to the physician's office from the distribution center. The patient is eligible for assistance for 18 months. If additional assistance is requested, a new application must be submitted to the hotline. In circumstances of significant financial need and serious medical hardship, individuals, with the help of their doctor, may appeal from denial of participation in this program.
The Patient or Advocate should contact the Hotline to apply on behalf of a patient. An application is sent to the caller for completion and signature by both the Patient and Doctor, in addition to a signed prescription. Upon receipt of completed application, prescription from physician, and approval of application, medication will be shipped directly to the physician's office from the distribution center. The patient is eligible for assistance for 18 months. If additional assistance is requested, a new application must be submitted to the hotline. In circumstances of significant financial need and serious medical hardship, individuals, with the help of their doctor, may appeal from denial of participation in this program.
Product(s) covered by program:
- SCULPTRA®
