RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

NOVARTIS PHARMACEUTICALS CORPORATION
Novartis Patient Assistance Foundation, Inc.

Exelon Patch (rivastigmine transdermal system)
 
CONTACT INFO
Address:
,
Phone: 1-800-277-2254 Provider Phone:
Fax: 1-855-817-2711 Website: Novartis Patient Assistance Foundation Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be a US resident.
  • Patient must meet program income requirements which may vary by product and household size.
  • Patient must have limited or no private or public prescription coverage.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    Both DEA and State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Provider
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Note: For Clozaril, Focalin XR and Ritalin LA the patient will receive a pharmacy card.
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: Contact program for refills
    Other Information:
    Additional products may be available. Please contact the program for a complete product listing. www.pap.novartis.com

    Last Updated: 08/23/2024

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2024, RxVantage, all rights reserved.