Bayer Patient Assistance - Adalat®

Bayer HealthCare Pha

Contact Information
Patient Assistance Program
6 West Belt, W66
Wayne, NJ 07470-6806
1-(866) 575-5002 (phone)
1-(866) 575-6568 (fax)
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.
To be accepted into the Bayer Patient Assistance Program, a patient must be a legal resident of the United States. Any patient who is enrolled in any Government Prescription Programs (other than a Medicare Part D Prescription Drug Benefit plan) or Private Prescription Plans including, but not limited to Medicaid, State-sponsored Prescription Assistance programs, or has employee, military, retirement, or pension program drug coverage is not eligible for the Bayer Patient Assistance Program. If the patient receives benefits from any of these types of programs or plans, the Bayer Patient Assistance Program cannot provide medication, even if the benefit program or plan does not cover the full cost of, or places limits on, medications. In the event that the patient does enroll in a Medicare Part D Prescription Drug Benefit plan, the patient will still be eligible to receive free medication under the Bayer Patient Assistance Program for this calendar year. **Pharmacy discount cards or pharmaceutical assistance programs are not insurance coverage. You may still apply if you participate in these programs.
Other Information:
The patient should first seek any available state or government assistance (Medicare Part D, State Prescription programs, Veteran’s Assistance, etc.) before applying to the Bayer Patient Assistance Program. The patient may be asked to supply paperwork supporting the denial of assistance from the programs mentioned above. Once it has been determined that the patient may be eligible for the Bayer Patient Assistance Program, the Doctor/Prescriber’s office should call our toll-free number: 1-866-575-5002 between 9 am and 5 pm EST. We will fax the necessary paperwork to enroll the patient. All forms must be completed by the Doctor/Prescriber and the patient and returned with current income documentation. Once the forms are completely filled out, they can be faxed or mailed back to us. A copy of all documentation should be kept for your records.
Product(s) covered by program:
  • Adalat®