COMPASSIONATE PROGRAM

Antipsychotics
Pharmaceutical Co. Representative Phone Medication Compassion Proram Availa!le"
#es$No
Eli Lilly Amelia Rigby 1-800-268-4446
ext 9317 or cell
799-7744
Olanzeine
!"yrexa#
$o %ormal rogram b&t can call Amelia %or
'amle'
(an''en Ort)o Le*erne +ayer 1-800-387-8781
ext 3681
Ri'eri,al
-tab
.)e %orm i' %ille, o&t by t)e )y'ician an,
%axe, to t)e n&mber on t)e %orm/
0enerally a 90 ,ay '&ly i' aro1e, an,
'ent o&t/ .)e Ri'er,al -tab i'
t)e only one a1ailable2 t)e reg&lar
Ri'er,al2 3)ic) 3e call comre''e,
tablet' are no3 generic an, t)ere%ore not
'&orte,/ 4orm Attac)e,/
0en +an 5a1e 6rennan 1-866-781-7274 Ri'eri,one +ontact 5a1e an, )e 3ill get
in%ormation %or yo&/ -ig)t be a bit
more comlicate, t)an +lozaine/
A'tra "eneca +&'tomer Relation' 1-800-668-6000 7ero8&el 9)y'ician can contact c&'tomer
relation' an, t)ey 3ill %ax o&t t)e
%orm/
Once it )a' been %axe, bac:2 t)e
alication 3ill be re1ie3e, an, t)e
criteria i' met2 t)ey 3ill bene%it %rom
t)eir rogram
0en +an 5a1e 6rennan 1-866-781-7274 +lozaine +ontact 5a1e ; )e 3ill a,1i'e t)e
)y'ician a' to 3)at in%ormation )e
nee,' in a letter %ormat/
Letter i' %axe, an, t)en re'ente, to
t)e committee 3)o 3ill eit)er
aro1e or not/
9age 1 o% 3
COMPASSIONATE PROGRAM
Antidepressants%
Pharmaceutical Co. Representative Phone Medication Compassion Proram Availa!le"
#es$No
+iralex- &elpin &ands% '()**(+,-(+./*
4or atient' on +iralex
Eac) ,octor can )a1e & to <
atient' %or t)i' me,ication
A ne3 %orm )a' to be comlete, %or
eac) re8&e't/ 9)one t)em an, t)ey
3ill %ax a %orm/
L&n,bec: 5anielle 6ea&c)e'ne 1-866-610-8338 +elexa $o 4ormal rogram b&t lea'e call 5anielle
an, ')e mig)t be able to 3or: 'omet)ing
o&t/
0laxo 7mit) =line 9)il 9eter' 1-800-461-7096
ext 9679
9axil +R +&rrently no %ormal aer3or:
+all lace, to t)e re/ 9re'crition
3ritten an, t)e re 3ill ic: & an,
initiate t)e re8&e't/
Organon (erome 7nei,erman 1-888-290-6061
or 1-416-290-
6061 ext 2274
Remeron R5 >a' genericize, 'e1eral mont)' ago
b&t coma''ionate &'e 3ill be
a1ailable &ntil t)e en, o% t)i' year
!,i'contin&e, in t)e $e3 ?ear#
@% t)ere are 'eci%ic one o%% ca'e'
lea'e contact (erome
$o1o)arm $o1o
-irtazaine
$o coma''ionate rogram a1ailable/
6io1ail 9)armace&tical' -ar: -ariano
!mar:/rarianoAbio1ail/com
#
292-<477 >elb&trin BL 4or all 6io1ail ro,&ct'2 a +oma''ionate
+are re8&e't ')o&l, be %axe, to 1-866-
20<-8131/
>e re8&ire t)e %ollo3ing iece' to be %axe,C
1/ A re'crition2 or any ,oc&ment
in,icating t)at t)e ,r&g )a' been
re'cribe, by a )y'ician/ 9lea'e )i,e t)e
9age 2 o% 3
COMPASSIONATE PROGRAM
name o% t)e atient on a coy/
2/ .)e a,,re'' o% a )armacy or an o%%ice
re8&e'ting t)e ,r&g2 a' it 3ill be co&rier
,eli1ere, t)ere %or a atient to ic: & D
contact )one n&mber/
Once 3e recei1e a re8&e't2 t)e ,r&g i'
')ie, t)e next b&'ine'' ,ay 1ia co&rier
%rom o&r 3are)o&'e in -i''i''a&ga/ @% a
,r&g i' bac:or,ere,2 a c&'tomer 3ill be
noti%ie,/
>yet) Ayer't 5enni' 7arling 1-800-461-3962
ext 2<62
E%%exor $o coma''ionate rogram a' ,r&g i'
going generic/
9age 3 o% 3