This program is intended for patients taking Synacthen® Depot

Knowledgeable Benefit Access Coordinators will assist you in accessing your private insurance or public health benefits that you or your dependents are entitled to.

The program will help you with;
• Reimbursement access assistance with all payer options.

• Payer support advocacy for all provincial formulary programs or private health insurance options to which you may be entitled.

• Co-pay funding assistance when you need help funding any co-payment requirements associated to your private drug plan.

• Provincial deductible funding assistance if associated with your public health plan.

This program is free to all enrolled patients that qualify and is fully confidential.

Complete the program enrollment form provided by your attending physician or print a blank enrollment form below and fax to 1-877-787-3376 (toll free)

Or mail to;
The Synacthen Depot Patient Support Program
c/o MEDICUM
1965 Ste Angélique #210,
St. Lazare, Quebec
J7T 0E2

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Last update: December 2018

The Synacthen® patient support program is supported by Valeo Pharma Inc and administered by Medicum.
Synacthen® is a registered trademark of Novartis AG and is used under licence by Questcor Operations Ltd.
Valeo Pharma Inc. reserves the right to modify or terminate this program at any time.