Rilutek Continuity and Patient Assistance Program


The Rilutek Continuity Hotline assists all patients with reimbursement questions for Rilutek. The Rilutek Patient Assistance Program is designed to help the uninsured and people in need better afford their prescription medicines, subject to financial restrictions.
Contact Information
Rilutek Continuity and Patient Assistance Program
P.O. Box 373
Somerville, NJ 08876
1-(800) 745-8835 (phone)
1-(866) 217-7178 (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.
Patient must be a legal resident of the United States. Patient's total annual household income must be consistent with sanofi-aventis guidelines. Please contact the program for more specific information. Patient cannot have any government or private prescription coverage for these products. The Patient must be treated by a licensed physician and have a valid prescription for our product.
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 patient from a mail-order pharmacy. The patient is eligible for assistance for 12 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 including denials based on Medicare Part D coverage.
Product(s) covered by program:
  • Rilutek®