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

Impax Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Impax Laboratories, Inc.

Impax Specialty Pharma Patient Assistance Program
PO Box 66554
St. Louis, MO 63166-6554

TEL: 877-764-9021


FAX: 877-764-9022
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Impax Patient Assistance Program Application

 

Medications

  • Albenza tablet (albendazole)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be a US resident
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe 7-10 business days
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Within 7-10 business days
Refill Process Not specified
Limit Up to one year
Re-application Company contacts patient about reapplying
   

Additional Information

Those with Medicare Part D must have spent at least 3% of annual household income out-of-pocket on prescription medicines.


Updated July 14, 2017