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Program 1 of 2.
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Rx Outreach Medications

This program provides medication at low cost. (Most brand names are provided for reference purposes only)

Provided by: Rx Outreach

PO Box 66536
St. Louis, MO 63166-6536

TEL: 888-796-1234


FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Diabetic Supplies Order Form (Prodigy)

Rx Outreach Refills and New Prescription Form

Rx Outreach Medication List

 

Medications

  • Abilify (aripiprazole)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly
   

Additional Information

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the Rx Outreach website for the exact price and most current medication list.

Contact Program for Spanish Application(s)/Form(s).


Updated October 03, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

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Otsuka Patient Assistance Foundation (OPAF) Patient Assistance Program

Provided by: Otsuka Patient Assistance Foundation, Inc.

Otsuka Patient Assistance Foundation, Inc.
PO Box 220248
Charlotte, NC 28222-0248

TEL: 855-727-6274


FAX: 844-727-6274
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Otsuka Patient Assistance Foundation Enrollment Form

Otsuka Code Reference Guide

Otsuka Code Reference Guide for Bipolar 1 Disorder

 

Medications

  • Abilify tablet (aripiprazole)
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? Varies
Income Varies
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax, mail or submit online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Not specified
Refill Process Not specified
Limit Varies
Re-application Varies
   

Additional Information


Updated September 25, 2017