This component of the program is made possible through Sanofi Cares North America. How to Apply: Select one of the links below to download the application or go to the program site for more information on how to apply. Hydroxychloroquine sulfate t Plaquenil and discoid lupus dosage Fundus autofluorescence in hydroxychloroquine toxicity Plaquenil uses In order to be eligible for the program, you must meet the following requirements You must be a resident of the U. S. or U. S. Territories and be under the care of a licensed healthcare provider authorized to prescribe, dispense and administer medicine in the U. S. or U. S. territories Hydroxychloroquine Plaquenil® Sanofi‐Synthelabo Inc. Sanofi Patient Assistance Program 1‐800‐992‐9022 Infliximab Remicade® Centocor, US Remicade Patient Assistance Program 1‐866‐489‐5957 Leflunomide Arava® Sanofi Aventis Sanofi Aventis Pharmaceuticals Patient Assistance Program 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. Patient's total annual household income must be below 250% of the Federal Poverty Line. Once you fill out your application, send it to the address on the application. Eligibility: Patient must be a legal resident of the United States. Plaquenil prescription assistance programs PAN Foundation - Systemic Lupus Erythematosus, Drug Name Brand Name Manufacturer Program Contact Information Plaquenil corneal verticillataChloroquine phosphate sigmaPrices for plaquenilDoes plaquenil cause heartburn Medications sent if accepted. Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application s/Form s. NeedyMeds. Plaquenil Prices, Coupons & Patient Assistance Programs.. Patient Enrollment. C3 independent non-profit organization providing financial assistance to adults and children to cover the cost of prescription drug coinsurance, copayments, deductibles, health insurance premiums and other selected out-of-pocket health care costs. 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. Coverage benefits For eligible patients, this program will pay up to $330 depending on financial situation per prescription/refill after patient has paid the first $20; patient will pay any remaining balance after program’s contribution.