Sculptra Program

Sculptra® Program Overview

The Galderma PAP program offers Sculptra® (injectable poly-L-lactic acid) at a reduced cost or no cost to patients for the restoration or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.

 

Patients enrolled in this program are eligible to receive up to 12 vials of Sculptra® over an initial 18-month enrollment period and may re-enroll for one additional year to receive up to 6 additional vials of product.

ELIGIBILITY GUIDELINES
Sculptra Eligibility Guidelines

Eligibility Guidelines

Patient eligibility is based both on the patient and healthcare provider’s responses to questions in the Program Application. The following general criteria apply:

  • Patient must submit a complete application
  • Healthcare provider must complete an application and provide a prescription to the specialty pharmacy
  • Patient must be a legal resident of the United States
  • Patient may not reside in a hospital, nursing home, correctional facility or court appointed program or facility
  • Patient cannot have government health insurance (Medicare, Medicaid, etc.)
  • Patient may have private health insurance
  • Patient must meet annual gross income requirements to participate in the reduced cost or no cost as shown in the table
  • Healthcare provider must have a McKesson Specialty account and have completed the Galderma Sculptra® injection training to receive product

Income Requirements

VIEW ANNUAL GROSS INCOME REQUIREMENTS (PDF)
PRODUCT SHIPMENT & REFILL
Sculptra Refill Requests

Initial Product Shipment

& Refill Requests

Once your application is approved a product shipment will be sent to your licensed injector from the program’s Specialty Pharmacy. Each shipment will include a minimum of 2 and a maximum of 4 vials of Sculptra®.

 

You must then request additional product shipment (i.e. refills) during the enrollment or re-enrollment period by submitting a refill request. This request should include your case number and correspond with an active prescription on file at our Specialty Pharmacy to be approved. You may be required to re-attest to the information you supplied on your initial application to complete the request.

 

A minimum of 7 business days is needed for each shipment to be processed.

How To Apply

1

Apply to the program by submitting an application form with the following information about you:

  • Contact details
  • Health insurance coverage
  • Household annual gross income and size
  • Healthcare provider's contact information

2

We will contact your healthcare provider to request that they provide supplemental information completing the application and send a prescription for the product to our Specialty Pharmacy.

3

A Patient Assistance Coordinator will review your application and notify you of the decision. If approved, you will be contacted to complete enrollment, which may include the submission of a co-payment for eligible products.

Application to the program

Application and

Re-enrollment Forms

Apply to the program
Request a refill

Frequently Asked Questions

You can re-enroll in this program for a maximum of 1 additional year.

Review our prescription savings program Galderma CareConnect and Aesthetic rewards program ASPIRE Galderma Rewards to see if these programs are a better fit for you.

When the provider is changed on an application, the application will require additional review and the patient may be asked to re-verify eligibility. This may cause delays in refill product shipments. If the current provider has already received product that has not been used, A Patient Assistance Program Coordinator will facilitate the return of the product to Galderma’s Specialty Pharmacy. Neither the patient or the provider should transfer the product to the new provider.  

  • Galderma Laboratories, L.P. and its U.S. distributor, McKesson Specialty Care Distribution LLC, are the only sources for FDA-approved Sculptra®. You will need to set up an account with McKesson in order to receive product. When you set up an account you will receive a McKesson Specialty Id (MKID) that is associated with your account.
  • The Galderma Sculptra® Injection training is a training that is required in order to receive and inject Sculptra®. To complete this training, you will navigate to www.myGAINtraining.com and follow the below steps:
  1. Register or Sign In to MyGAINTraining.com using your MKID  
  2. Navigate to the “Sculptra” tab on the left
  3. Click “Account Activation”
  4. Complete the Training

Sculptra® may be provided through the Galderma Patient Assistance Program at a reduced cost. Eligible patients will be required to provide a co-payment to the Program prior to each shipment of product to the healthcare provider. The amount of this payment is based on household size and income and will be shared by a Program Coordinator during enrollment.    

Questions?

Contact a Program Coordinator

Monday - Friday | 8:00 am - 5:00 pm CT | 1-855-431-3737