Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Boehringer Ingelheim Cares Foundation Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Boehringer Ingelheim Cares Foundation, Inc.

PO Box 66745
St. Louis, MO 63166-6745

TEL: 800-556-8317


FAX: 866-851-2827
Languages Spoken:

English Others By Translation Service

Program Website

 

Program Applications and Forms

Boehringer Ingelheim Cares Application

HIV Common Application: Boehringer Ingelheim Cares (APTIVUS, VIRAMUNE XR)

 

Medications

  • Aptivus (tipranavir)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? Yes, but contact program for details
Income Based on FPL
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 proof of income and other requested documentation
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient or Doctor's office needs to contact company
Limit Not specified
Re-application New application yearly
   

Additional Information

Eligibility determined on a case-by-case basis based on eligibility criteria.
Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.

For Gilotrif, patient must not use this programs application. Please contact the BI Cares Foundation Gilotrif Patient Assistance Program at 877-814-3915.


Updated July 05, 2017


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

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • Aptivus (tipranavir)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.


Updated June 29, 2017