This component of the program is made possible through Sanofi Cares North America. M05.60, M05.611, M05.612, M05.619, M05.621, M05.622, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.9, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.4, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.9, M08.00, M08.011, M08.012, M08.019, M08.021, M08.022, M08.029, M08.031, M08.032, M08.039, M08.041, M08.042, M08.049, M08.051, M08.052, M08.059, M08.061, M08.062, M08.069, M08.071, M08.072, M08.079, M08.09, M08.20, M08.211, M08.212, M08.219, M08.221, M08.222, M08.229, M08.231, M08.232, M08.239, M08.241, M08.242, M08.249, M08.251, M08.252, M08.259, M08.261, M08.262, M08.269, M08.271, M08.272, M08.279, M08.28, M08.29, M08.40, M08.411, M08.412, M08.419, M08.421, M08.422, M08.429, M08.431, M08.432, M08.439, M08.441, M08.442, M08.449, M08.451, M08.452, M08.459, M08.461, M08.462, M08.469, M08.471, M08.472, M08.479 Rheumatoid arthritis (RA) is an inflammatory disorder in which the immune system attacks its own tissues. Plaquenil and macular pucker Plaquenil and puffy face This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level. The patient is eligible for assistance for 12 months. If additional assistance is requested, a new application must be submitted to the hotline. In circumstances of significant financial need and serious medical hardship, individuals, with the help of their doctor, may appeal from denial of participation in this program including denials based on Medicare Part D coverage. Hydroxychloroquine Prices, Coupons & Patient Assistance. HYDROXYCHLOROQUINE is used to treat rheumatoid arthritis and systemic lupus erythematosus. It is also used to treat malaria. The lowest GoodRx price for the most common version of hydroxychloroquine is around $18.60, 89% off the average retail price of $175.77. 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. RA is a chronic disease that affects the immune system. Hydroxychloroquine assistance program Hydroxychloroquine Plaquenil, Sanofi-Aventis Patient Assistance Program - Plaquenil confusion The third type is a patient assistance foundation. These are independent organizations that are usually not-for-profit. The programs that these groups offer seek to alleviate the financial burden of affording expensive medications by locating co-pay assistance programs and pharmaceutical assistance programs for the individual consumer. Co-pay Cards and Financial Assistance for Arthritis Patients.. Hydroxychloroquine Prices, Coupons & Savings Tips - GoodRx. Sanofi Patient Connection™ Financial Support & Resources. Speak to your prescribing physician and ask if the prescribed medication has a co-pay card assistance program or you can visit to find co-pay card assistance programs. Fill out the co-pay card enrollment form provided by your prescriber and send the form to the appropriate drug manufacturer. Plaquenil Prices, Coupons and Patient Assistance Programs Plaquenil hydroxychloroquine is a member of the antimalarial quinolines drug class and is commonly used for Dermatomyositis, Lyme Disease - Arthritis, Malaria, and others. Apr 30, 2018 PLAQUENIL hydroxychloroquine sulfate tablets contain 200 mg hydroxychloroquine benefit to the patient outweighs the possible hazard. divided doses for adults may be administered for a few days to acidify the urine to help promote.