Hydroxychloroquine is available as the brand-name drug Plaquenil. Generic drugs usually cost less than the brand-name version. Hydroxychloroquine may be used as part of a combination therapy. Chloroquine glutathione synthase Michael marmor plaquenil dec 2015 Chloroquine alcohol use The patient must be getting treatment for systemic lupus erythematosus. The patient must have health insurance that covers his or her qualifying medication or product. The patient’s medication or product must be listed on PAN’s list of covered medications. The patient’s income must fall at or below 500% of the Federal Poverty Level. Hydroxychloroquine Plaquenil is considered a disease-modifying anti-rheumatic drug DMARD. It can decrease the pain and swelling of arthritis. It may prevent joint damage and reduce the risk of long-term disability. Hydroxychloroquine is in a class of medications that was first used to prevent and treat malaria. Depending on the health insurance plan, savings may apply toward co-pay, co-insurance or deductible. Eligible patients pay $5 per injection with a $20,000 maximum program benefit per calendar year. Not valid for patients using Medicare, Medicaid, or other government-funded programs to pay for their medications. Hydroxychloroquine is used to treat lupus erythematosus and rheumatoid arthritis. It isn’t fully understood how this drug works to treat lupus erythematosus or rheumatoid arthritis. That means you may need to take it with other drugs. It treats malaria by killing the parasites that cause the disease. Plaquenil patient assistance forms Welcome to HealthWell’s Online Application, Hydroxychloroquine Plaquenil Hydroxychloroquine side effects diarrheaChloroquine phosphate injection usesHydroxychloroquine lymphadenopathyPlaquenil price increase The Bristol-Myers Squibb Patient Assistance Foundation, Inc. BMSPAF is a non-profit organization that seeks to help eligible patients get the following medicines for free ELIQUIS ® apixaban NULOJIX ® belatacept ORENCIA ® abatacept BMS 207 PAF Application-Form RD7. Patient Resources SIMPONI® golimumab. PAN Foundation - The Help You Need. Patient Assistance Programs for Plaquenil. Patient assistance programs PAPs are usually sponsored by pharmaceutical companies and provide free or discounted medicines to low income or uninsured and under-insured people who meet specific guidelines. Eligibility requirements vary for each program. Re-application New application every 12 months Additional Information *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease. Who Is This Form For? This enrollment form is for Prescribers who have uninsured patients who need help paying for Prevnar 13 ® Pneumococcal 13-valent Conjugate Vaccine Diphtheria CRM 197 Protein and/or Trumenba ® Meningococcal Group B Vaccine. Through the Pfizer Patient Assistance Program, Prescribers' purchased stock of the vaccine is replenished when administered to eligible.