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Information for Healthcare Providers and Clinics
We appreciate your commitment to your patients and especially your assistance in helping your uninsured patients obtain access to Mirena®. Our goal is to make the application process as simple as possible for both you and your patients. We do, however, need to receive specific information in order to be able to assess your patient's eligibility for assistance. The process is as follows:
- The healthcare provider and the patient must complete the application form.
- Healthcare providers and patients may contact the ARCH Foundation at 1-877-393-9071 to obtain an application and/or discuss whether a specific patient is likely to be eligible for assistance.
- Patient case coordinators are available to assist you and your patients with questions regarding the application and the application process.
- Review of the application will be completed in approximately two business days from receipt of a complete application.
- You and your patient will be notified in writing regarding the review of your patient's application for assistance. If assistance is approved, we will send the product to your office (as designated on the application).
- If your patient does not have insurance coverage for the insertion of Mirena we encourage you to provide free insertion of the donated Mirena unit.
- Similarly, in the spirit of assisting your low income, uninsured patients, we encourage you to accommodate an uncomplicated removal at no charge to the patient.
We appreciate your use of the donated Mirena units to help meet the needs of women who have no other way to obtain Mirena. Because of the current demand for the units available through the ARCH Foundation, the Foundation must limit the number of Mirena units provided to your facility's clients to 60 units per year. Once this limit has been reached, the Foundation will inform you that your annual allocation has been reached. We appreciate your interest in Mirena as an effective choice for your clients and your help in this effort to manage our resources so as to provide access to Mirena to women nationwide who meet the program eligibility criteria.
