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Medication
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Company
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Program Details
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Buspar (buspirone)
Serzone (nefazadone) |
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Bristol-Meyers Squibb toll-free 800.736.0003 |
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- provider signature
- copy form
- three-month supply and one refill
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| Celexa (citalopram) |
|
Forest toll-free 800.851.0758 |
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- patient and provider signature
- financial disclosure
- three-month supply
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| Consta (risperidone long- acting) |
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Constant Access Janssen phone -- 877.747.7524, extension 5339 |
|
- patient and provider signature
- three months approved at a time
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Clozaril (clozapine)
Tegretol XR (carbamazepine) |
|
Novartistoll-free 800.277.2254 |
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- patient and provider complete
- one-month approval
- 60 and 90 day refills
- $5 co-payment
|
| Depakote (divalproex sodium) |
|
Abbott toll-free 800.441.4987, extension 4 |
|
- call for individual form
- financial disclosure
- three-month supply
|
| Effexor Effexor XR (venlafaxine) |
|
Wyeth-Ayerst toll-free 800.568.9938 |
|
- patient and provider signature
- three-month supply
- copy form
|
| Gabitril (tiagabine) |
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Cephalon toll-free 800.511.2120 |
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- patient and provider signature
- financial disclosure
- three-month supply with coupon
|
Lamictal (lamotrigine)
Paxil (paroxetine)
Wellbutrin SR (bupropion) |
|
Glaxo-SmithKline "Bridges to Access" toll-free 866.728.4368 |
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- patient and provider signature
- $10 co-payment for 60-day supply
- two free mail order 90-day supplies
- one form all drugs
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| Zoloft (sertaline) |
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Pfizer "Connection to Care"toll-free 800.707.8990 |
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- financial disclosure on form
- provider signature
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| Risperdal (risperidone) |
|
Janssen toll-free 800.652.6227 |
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- patient and provider signature
- one year approval sent monthly
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| Seroquel (quetiapine fumarate) |
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Astra Zeneca (patient assistance not needed) |
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- BJCBH & BHP patients have full access to Seroquel through an inventory replenishment program
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| Zyprexa (olanzapine) |
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Zyprexa toll-free 800.488.2133 |
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- financial disclosure
- copy form
- four-month supply
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