Tolak Patient assistance program
Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Tolak medication with our help.Get started today
- Secure: Your personal and medical information is safe with us
- Convenient: We manage the whole process and we’re here to assist you
- Ongoing refills: We request your medication refills on your behalf
NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.
An introduction to NiceRx(01:52)
Next steps after qualifying(00:38)
Uploading documents and billing(00:50)
SSN & billing information(00:33)
Medication delivery time(00:41)
How it works
Get started by filling out the online enrollment application to find out if you are eligible.
NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified. The pharmaceutical company provides your medication for free and you only pay our service fee.
You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.
Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.
Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.
Your monthly Tolak cost savings if eligible
If you are eligible for the Tolak patient assistance program you can receive your medication for free. Our monthly service fee of $49 per medication covers the cost of our services in applying for the program and requesting your ongoing refills on your behalf. If you obtain your Tolak through NiceRx, you will only pay $49 a month regardless of the retail price of your medication.
Am I eligible for the Tolak patient assistance program?
You could receive your Tolak without paying the full retail price if you meet the eligibility criteria for assistance. The eligibility requirements are set by the pharmaceutical companies who are providing assistance programs. At NiceRx, we review each application individually, although the main factors considered by most programs are:
- I am a permanent, legal resident of the United States or Puerto Rico
- I am uninsured or my insurance doesn’t cover my medication
- I meet certain income eligibility requirements
How do I apply for Tolak patient assistance?
We do everything that we can to take the hassle and stress out of applying for patient assistance programs. Simply start by filling in our enrollment application. We will ask for details about your healthcare provider, your insurance, and your household income. This information is required by the pharmaceutical companies you are applying to for assistance. We may also be able to help you access patient assistance for other medications that you have been prescribed, so be sure to tell us about any medications you are taking as well as Tolak.
NiceRx will review the information you have provided, and if we determine that you may be eligible for assistance, we will seek to enroll you in the Tolak patient assistance program. We will handle the enrollment process for you by working with your healthcare provider and preparing all the required paperwork for your doctor to sign. We will also request your Tolak medication refills on your behalf for up to 1 year once you are enrolled in the program.
Is NiceRx a Tolak coupon provider?
At NiceRx, we help eligible individuals access the Tolak patient assistance program. This means that we are not a Tolak coupon, a Tolak discount card, or a Tolak copay card provider. We do not offer any medication trial offers, or free Tolak samples.
Can NiceRx help me get Tolak cheaper if I have insurance?
We may be able to help you if you have insurance, including if your insurance company will not pay for your Tolak medication, or if you have a high copay or coinsurance responsibility. We may even be able to assist if you do not have insurance. Please fill in our enrollment application to find out more.
How much does Tolak cost without insurance?
Tolak costs without insurance will vary depending on how much you buy and the retailer you buy it from. As a guide, Tolak topical cream 4% will typically cost around $270 for 40 grams. If you obtain your medication through NiceRx, you will pay a flat monthly rate of $49 per medication regardless of its retail price.
How much does Tolak cost with insurance?
The copay of Tolak will vary in line with the specific terms of your healthcare plan. For further details about what you may need to pay, your insurance provider or pharmacist will be able to calculate the copay costs with your current insurance.
What is Tolak?
Tolak is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Hill Dermaceuticals. Tolak cream is classed as an antineoplastic antimetabolite. It is used for the treatment of skin lesions called actinic keratosis on the face, ears, or scalp.
What doses of Tolak are available?
Tolak is available in cream form, in the following doses: 0.04g in 1g.
Fluorouracil topical cream is for topical use only on the affected area of the skin. It is not for ophthalmic, oral, or intravaginal use. Wash your hands before and immediately after applying Tolak. Apply the cream to cover the affected skin condition with a thin film. You may need to use Tolak for up to 6 weeks. Do not use Tolak on or around your eyelids or in your eyes, nose, or mouth, or other mucous membranes.
Topical fluorouracil is linked to photosensitivity reactions. You are advised to avoid sunlight, sunlamps, or tanning beds while using this treatment as Tolak can make your skin more sensitive to sunlight and cause it to sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) if you are going outdoors. Store the cream at room temperature away from moisture and heat.
Please read the patient information provided and always speak with a healthcare professional for medical advice about any changes to your dose so they can monitor and evaluate your condition.
Tolak active ingredients
Tolak contains fluorouracil as the active ingredient.
Tolak side effects
The most common side effects of Tolak cream in clinical trials include:
- Skin reactions, such as pain, itching, burning, irritation, and inflammation
- Hair loss
- Tenderness and crusting at the site of application
In rare instances, Tolak can cause more serious side effects. These can include:
- Severe pain, swelling, itching, burning, or irritation
- New or worsening skin sores
- Fever, chills
- Severe abdominal pain, bloody diarrhea, vomiting
Your doctor will assess the benefits of using Tolak against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Tolak to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Tolak drug interactions
Other drugs may interact with Tolak, including prescription drugs and over-the-counter medicines, vitamins, and herbal products. Tell your health care provider about all of your medication including any supplements you are taking.
You should not use Tolak if you:
- Are allergic to the active ingredient fluorouracil
- Have had an allergic reaction to any of the other inactive ingredients in Tolak
- Have DPD deficiency (dihydropyrimidine dehydrogenase)
- Are allergic to peanut oil (Tolak contains peanut oil)
- Are younger than 18 years of age
- Are pregnant or are planning to become pregnant – Fluorouracil can cause harm to an unborn baby, such as birth defects and miscarriage, use effective birth control
- Are breastfeeding or are planning to breastfeed – It is not known if this medication passes into breast milk
Talk to your doctor about your medical condition before using Tolak if you:
- Are taking any of the medications that could interact with Tolak
Tolak is the trademark brand name for fluorouracil cream manufactured by Hill Dermaceuticals. A generic version of fluorouracil is available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Tolak savings through NiceRx.
*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking down the different programs and filling out all the required paperwork for each program.
Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.
**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).
To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.