CALL US AT
CALL US AT
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)
Patients can APPLY ONLINE HERE. THIS IS THE EASIEST METHOD.
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
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.