Beyaz

Indicated For

contraception, premenstrual dysphoric disorder (PMDD), acne

About This Medication

# Bayer US Patient Assistance Foundation Patient Guide: How to Get Beyaz at Low or No Cost ## About This Program The **Bayer US Patient Assistance Foundation** is a charitable organization designed to help eligible patients access their Bayer prescription medications at no cost when facing financial challenges.[3][4] If you've been prescribed Beyaz (drospirenone/ethinyl estradiol/levomefolate calcium) but struggle to afford it, this program may be able to help you get your medication for free. ## About Beyaz Beyaz is an oral contraceptive that combines three active ingredients: drospirenone (a progestin), ethinyl estradiol (an estrogen), and levomefolate calcium (a form of folic acid). This combination is used for birth control and may help reduce the risk of neural tube defects. Like other hormonal contraceptives, Beyaz requires a prescription and ongoing refills. ## Who Can Qualify? You may be eligible for the Bayer US Patient Assistance Foundation program if you meet these criteria:[2] - **Live in the United States or Puerto Rico** - **Are uninsured or underinsured** — meaning you don't have insurance coverage for Beyaz, or your insurance doesn't cover this specific medication - **Meet financial need requirements** — the program evaluates your household income and financial situation - **Have a valid prescription** from your doctor for Beyaz The program prioritizes patients who have exhausted other assistance options, including state and government programs.[5] ## Income Eligibility While the Bayer US Patient Assistance Foundation does not publish specific income thresholds, the program uses a **needs-based approach** to determine eligibility.[5] This means the program evaluates your individual financial circumstances rather than applying a strict income cutoff. When applying, you'll need to provide **proof of income** documentation, such as: | Documentation Type | Examples | |---|---| | Recent pay stubs | Last 2-3 months of earnings | | Tax returns | Most recent year's federal return | | Benefit statements | Social Security, unemployment, disability statements | | Bank statements | To verify financial hardship | | Proof of residency | Utility bill, lease, or government ID | If you receive Medicare Part D benefits with a Low-Income Subsidy (LIS), you must provide **proof of denial from the LIS program** ("Extra Help") before the Foundation will consider your application.[1] ## Insurance Requirements The program is designed for **uninsured and underinsured patients**.[2][5] Here's what this means: - **Uninsured**: You have no health insurance coverage at all - **Underinsured**: You have insurance, but Beyaz is not covered, or your out-of-pocket costs are prohibitively high **Important Medicare Note**: If you're a Medicare Part D beneficiary, you may still be eligible to receive free medication through this program for the calendar year, even if you're enrolled in a prescription drug plan.[5] The Foundation does **not** accept applications from patients whose commercial or employer-sponsored insurance participates in alternative funding programs that require manufacturer assistance applications.[1] ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect:[2][5] - Proof of income (pay stubs, tax returns, or benefit statements) - Proof of residency (utility bill or government ID) - Your current prescription for Beyaz - Insurance information (if applicable) ### Step 2: Complete the Patient Information Section Download the application form from the Bayer US Patient Assistance Foundation website or request one by phone at **1-866-228-7723** (Monday-Friday, 9 AM-6 PM EST).[1][2][5] Complete pages 2-5 of the application with your personal information, including: - Your name and contact information - Household income details - Insurance status - Your caregiver's information (optional) You or a caregiver can complete this section.[2] ### Step 3: Get Your Doctor's Signature Ask your prescribing doctor or healthcare professional to complete and sign the **Healthcare Professional Section** (page 6) of the application.[2] This confirms your prescription and medical need for Beyaz. ### Step 4: Make a Copy Before submitting, make a copy of the completed and signed application for your records.[2] ### Step 5: Submit Your Application Submit your completed, signed application along with proof of income by **fax or mail**:[1][2][5] **Fax**: 1-866-575-6568 **Mail**: Bayer US Patient Assistance Foundation P.O. Box 5670 Louisville, KY 40255 **Online Option**: You may also enroll online at the McKession HubConnect portal.[5] ### Step 6: Follow Up If you don't hear back within 2 business days, contact the Foundation at **1-866-228-7723** to confirm receipt of your application.[6] ## Timeline and Medication Delivery **Application Review**: Applications are typically reviewed within **2 business days**, though processing may take longer if information is missing or incomplete.[6] **Approval and Delivery**: Once approved, your Beyaz will be **shipped directly to you** at no cost. For most patients, the one-year benefit period begins immediately upon approval. For Medicare Part D beneficiaries, the benefit year begins on January 1.[7] **Duration**: The program provides free medication for **one year** from your approval date (or January 1 for Medicare Part D patients).[7] ## What If Your Application Is Denied? If your application is denied, you have several options: - **Request clarification** from the Foundation about the denial reason by calling 1-866-228-7723 - **Reapply** if your financial situation changes or if you can provide additional documentation - **Explore alternatives**: Ask your doctor about generic versions of hormonal contraceptives or other birth control options - **Contact your state health department** for additional assistance programs - **Look into copay assistance programs** if you have commercial insurance (separate from this patient assistance program) ## Reauthorization and Refills **Reauthorization is required** to continue receiving free Beyaz after your one-year benefit period ends.[5] You'll need to: 1. Reapply before your current benefit year expires 2. Provide updated proof of income and residency 3. Have your doctor sign a new authorization form Contact the Foundation 30 days before your benefit year ends to request a renewal application. ## Biosimilar and Alternative Options If you're denied assistance or prefer to explore other options, ask your doctor about: - **Generic drospirenone/ethinyl estradiol formulations** (such as RAJANI by Teva), which are typically more affordable than brand-name Beyaz - **Other hormonal contraceptives** covered by your insurance or available at lower cost - **Community health center programs** that may offer discounted or free contraception ## Important Reminders - **Your application cannot be reviewed without a fully completed and signed form** from both you and your healthcare provider.[2] - **Use the checklist on page 7** of the application to ensure all required information is included before submitting.[2] - **Notify the Foundation immediately** if your insurance status changes while you're enrolled in the program.[7] - **The program is needs-based**, so eligibility is determined on a case-by-case basis. ## Contact Information **Phone**: 1-866-228-7723 (1-866-2BUSPAF) **Hours**: Monday-Friday, 9 AM-6 PM EST **Website**: www.patientassistance.bayer.us **Fax**: 1-866-575-6568 **Mailing Address**: Bayer US Patient Assistance Foundation, P.O. Box 5670, Louisville, KY 40255 ## Disclaimer This guide provides general information about the Bayer US Patient Assistance Foundation program based on publicly available information. Program eligibility, requirements, and benefits may change. For the most current and accurate information, contact the Foundation directly or visit their official website. This guide is not a guarantee of program eligibility or approval. Always consult with your healthcare provider about your medication options and financial assistance programs.

Program information last verified: March 30, 2026