Eloxatin Reimbursement Hotline and Patient Assistance Program
Sanofi-Synthelabo, I
Contact Information
Eloxatin Reimbursement Hotline
Po Box 1074
San Bruno, CA 94066
1-(800) 435-6928 option5 (phone)
1-(877) 366-0584 (fax)
Eloxatin Reimbursement Hotline
Po Box 1074
San Bruno, CA 94066
1-(800) 435-6928 option5 (phone)
1-(877) 366-0584 (fax)
Eligibility:
1. Patient must be under the care of a health-care provider duly licensed and authorized to prescribe, dispense and administer ELOXATIN. 2. Patient must meet the financial criteria established for enrollment. 3. Financial information must be provided for the application to be considered, and the health-care provider must obtain documentary support for the financial information (eg. tax returns). This support is not sent with the application but must be retained by the provider and subject to audit.
1. Patient must be under the care of a health-care provider duly licensed and authorized to prescribe, dispense and administer ELOXATIN. 2. Patient must meet the financial criteria established for enrollment. 3. Financial information must be provided for the application to be considered, and the health-care provider must obtain documentary support for the financial information (eg. tax returns). This support is not sent with the application but must be retained by the provider and subject to audit.
Other Information:
The physician's office should contact the Eloxatin Reimbursement Hotline to apply on behalf of a patient. An application is sent to the physician's office for completion and signature, in addition to a signed prescription. Upon receipt of completed application, disclosure form and prescription from physician, and upon approval of application, medication will be shipped directly to the physician's office from the distribution center. Each patient can receive upto a 1-month supply of medication per prescription. The patient's program must be recertified every 3 months. The physician must fax prescription refills to the hotline.
The physician's office should contact the Eloxatin Reimbursement Hotline to apply on behalf of a patient. An application is sent to the physician's office for completion and signature, in addition to a signed prescription. Upon receipt of completed application, disclosure form and prescription from physician, and upon approval of application, medication will be shipped directly to the physician's office from the distribution center. Each patient can receive upto a 1-month supply of medication per prescription. The patient's program must be recertified every 3 months. The physician must fax prescription refills to the hotline.
