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Helping uninsured, income-eligible patients overcome financial barriers, the Compassionate Care Program is designed to provide eligible patients savings on Gonal-f® (follitropin alfa for injection), Ovidrel® PreFilled Syringe (choriogonadotropin alfa injection), or Cetrotide® (cetrorelix acetate for injection).

Depending on income, eligible patients may save 25%, 50%, or 75% off the self-pay price of medicine or receive a 10% discount per unit, via a mail-in rebate, off their out-of-pocket costs for the following EMD Serono fertility products:

GONAL-F® RFF* Redi-ject (follitropin alfa injection) 300 IU
GONAL-F® RFF* Redi-ject (follitropin alfa injection) 450 IU
GONAL-F® RFF* Redi-ject (follitropin alfa injection) 900 IU
GONAL-F® MULTI-DOSE (follitropin alfa for injection) 450 IU
GONAL-F® MULTI-DOSE (follitropin alfa for injection) 1050 IU
GONAL-F® RFF* (follitropin alfa for injection) 75 IU, single vial pack
GONAL-F® RFF* (follitropin alfa for injection) 75 IU, 10 vial pack

OVIDREL® PREFILLED SYRINGE (choriogonadotropin alfa injection)

CETROTIDE® (cetrorelix acetate for injection)

HOW TO APPLY

Patients can APPLY ONLINE HERE.  THIS IS THE EASIEST METHOD.

OR 

DOWNLOAD AN APPLICATION HERE (English Version)  

Spanish Version – forma en espanol

Then submit via one of the following options

Send completed enrollment forms to:
Mail: Compassionate Care Program
6501 Weston Parkway, Suite 370
Cary, NC 27513

OR

Fax: (919) 415-2870

APPLICATIONS ARE NO LONGER ACCEPTED VIA EMAIL. IF YOU WISH TO SUBMIT ELECTRONICALLY, PLEASE DO SO HERE.

*Although Mandell’s Clinical Pharmacy is a participating provider for Compassionate Care and offers this program through our pharmacy, it is a third party program.   Mandell’s does not determine or influence patient eligibility or acceptance.