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

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

 

Patient Assistance Applications

Rx Outreach Application

Rx Outreach Diabetic Supplies Order Form (Prodigy)

Rx Outreach Refills and New Prescription Form

Rx Outreach Medication List

 

Brand Name Medications Covered

 
  • Abilify
  • Mestinon
  • Accolate
  • Metadate CD
  • Accupril
  • Miacalcin
  • Accuretic
  • Micardis
  • AcipHex
  • Microzide
  • Aclovate
  • Minocin
  • Actonel
  • Mirapex
  • Actos
  • Mobic
  • Adderall XR
  • Monoket
  • Advair
  • Myfortic
  • AirDuo RespiClick
  • Mysoline
  • Alaway
  • Namenda
  • Aldactone
  • Naprosyn
  • Allegra
  • Nardil
  • Altace
  • Neurontin
  • Amaryl
  • Nexium
  • Ambien
  • Niacor
  • Ambien CR
  • Niaspan
  • Androxy
  • Nilandron
  • Antivert
  • Nitrostat
  • Aricept
  • Norvasc
  • Arimidex
  • Nyamyc
  • Astelin
  • Ogen
  • Atacand
  • Ortho Micronor
  • Atacand HCT
  • Ortho Tri-Cyclen
  • Ativan
  • Ortho-Cyclen
  • Avalide
  • Ovcon 35
  • Avapro
  • Oxandrin
  • Avodart
  • Pacerone
  • Azilect
  • Pamelor
  • Azor
  • Panretin
  • Azulfidine En-Tab
  • Parafon Forte DSC
  • Bactrim
  • Pataday ophthalmic solution/drops
  • Benicar
  • Patanase spray; nasal
  • Benicar HCT
  • Patanol ophthalmic solution/drops
  • Bentyl
  • Paxil
  • Calan
  • Paxil CR
  • Calan SR
  • Pepcid
  • Capoten
  • Phoslo
  • Carafate
  • Plaquenil
  • Cardizem CD
  • Plavix
  • Cardura
  • Plendil
  • Casodex
  • Pletal
  • Catapres
  • Prandin
  • Catapres-TTS-3
  • Pravachol
  • Celebrex
  • Prevacid
  • Celexa
  • Prevalite
  • Cellcept
  • Prilosec
  • Claritin
  • Prinivil
  • Cleocin
  • Prinzide
  • Colazal
  • Pristiq
  • Colestid
  • Proair Respiclick
  • Coreg
  • Procardia XL
  • Cosopt
  • Prograf
  • Coumadin
  • Proscar
  • Cozaar
  • Protonix
  • Crestor
  • Provera
  • Cymbalta
  • Provigil
  • Cytomel
  • Prozac
  • Depakene
  • Pulmicort Respules
  • Depakote
  • Qudexy XR
  • Depakote ER
  • Reglan
  • Depo-Testosterone
  • Relpax
  • Detrol
  • Remeron
  • Dibenzyline
  • Renvela
  • Diflucan
  • Requip
  • Dilacor XR
  • Restoril
  • Dilantin
  • Revatio
  • Diovan
  • Rhinocort
  • Diovan HCT
  • Risperdal
  • Diprolene AF
  • Ritalin
  • Ditropan
  • Ritalin LA
  • Donnatal
  • Robaxin
  • Donnatal Elixir syrup
  • Rocaltrol
  • DuoNeb
  • Rythmol
  • Dutoprol
  • Septra
  • Dyazide
  • Seroquel
  • Dynacin
  • Seroquel XR
  • Dyrenium
  • Sinemet
  • Effexor XR
  • Sinemet CR
  • Elocon
  • Singulair
  • Enablex
  • Sonata
  • Entocort EC
  • Sorine
  • Enulose
  • SSKI
  • Epitol
  • Stalevo
  • Estrace
  • Strattera
  • Evista
  • Synthroid
  • Evoxac
  • Tapazole
  • Exelon
  • Tegretol
  • Exforge
  • Tegretol XR
  • Exforge HCT
  • Tenoretic
  • Famvir
  • Tenormin
  • Femara
  • Tessalon
  • Flomax
  • Topamax
  • Flonase
  • Toprol XL
  • Focalin
  • Trental
  • Folgard
  • Tricor
  • Folgard OS
  • Trileptal
  • Folgard RX
  • Trilipix
  • Fosamax
  • Trusopt
  • Geodon
  • Ultracet
  • Glucophage
  • Ultram
  • Glucophage XR
  • Ultram ER
  • Glucotrol
  • Ultravate
  • Glucotrol XL
  • Urecholine
  • Glucovance
  • UroXatral
  • Glynase
  • Valium
  • Hexalen
  • Valtrex
  • Hydrea
  • Vaseretic
  • Hyzaar
  • Vasotec
  • Imitrex
  • Viagra
  • Imuran
  • Vogelxo
  • Intuniv
  • Voltaren XR
  • Isoptin
  • Wellbutrin
  • Jantoven
  • Wellbutrin SR
  • Keppra
  • Wellbutrin XL
  • Keppra XR
  • Xalatan
  • Klonopin
  • Xanax
  • Lamictal
  • Xanax XR
  • Lanoxin
  • Xeloda
  • Lasix
  • Xopenex
  • Levoxyl
  • Xyzal
  • Lexapro
  • Zanaflex
  • Lidoderm
  • Zantac
  • Lipitor
  • Zaroxolyn
  • Lithobid
  • Zestoretic
  • Lofibra (Micronized)
  • Zestril
  • Lomotil
  • Zetia
  • Lonox
  • Ziac
  • Lopid
  • Zofran
  • Lopressor
  • Zofran ODT
  • Lotensin
  • Zoloft
  • Lotensin HCT
  • Zonegran
  • Lotrel
  • Zovirax
  • Lotrisone
  • Zyloprim
  • Lovaza
  • Zyprexa
  • Lunesta
  • Zyrtec
  • Maxzide
 

Generic Name

 
  • acyclovir
  • ipratropium bromide-albuterol
  • albuterol
  • irbesartan
  • alclometasone dipropionate
  • irbesartan/hydrochlorothiazide
  • alendronate sodium
  • isosorbide mononitrate
  • alfuzosin
  • ketotifen fumarate
  • alitretinoin
  • labetalol
  • allopurinol
  • lactulose
  • alprazolam
  • lamotrigine
  • altretamine
  • lansoprazole
  • amantadine
  • latanoprost
  • amiodarone
  • letrozole
  • amitriptyline
  • levalbuterol
  • amlodipine
  • levetiracetam
  • amlodipine besylate
  • levocetirizine
  • amlodipine besylate/benazepril
  • levothyroxine
  • amlodipine besylate/olmesartan medoxomil
  • lidocaine
  • amlodipine besylate/valsartan
  • liothyronine sodium
  • amlodipine besylate/valsartan/hydrochlorothiazide
  • lisinopril
  • amoxapine
  • lisinopril/hydrochlorothiazide
  • anastrozole
  • lithium carbonate
  • aripiprazole
  • loperamide
  • aspirin
  • loratadine
  • atenolol
  • lorazepam
  • atenolol/chlorthalidone
  • losartan
  • atomoxetine
  • lovastatin
  • atorvastatin calcium
  • loxapine succinate
  • atropine/diphenoxylate
  • magnesium oxide
  • azathioprine
  • meclizine
  • azelastine
  • medroxyprogesterone acetate
  • baclofen
  • meloxicam
  • balsalazide disodium
  • memantine
  • belladonna alkaloids/phenobarbital syrup
  • metformin
  • benazepril
  • methimazole
  • benazepril/hydrochlorothiazide
  • methocarbamol
  • benzonatate
  • methotrexate
  • benztropine
  • methylphenidate
  • betamethasone dipropionate
  • metoclopramide
  • bethanechol
  • metolazone
  • bicalutamide
  • metoprolol succinate/hydrochlorothiazide
  • bisoprolol fumarate/hydrochlorothiazide
  • metoprolol sussinate
  • brimonidine tartrate
  • metoprolol tartrate
  • bromocriptine
  • midodrine
  • budesonide
  • minocycline
  • bupropion
  • mirtazapine
  • buspirone
  • modafinil
  • calcitonin salmon
  • mometasone furoate
  • calcitriol
  • montelukast sodium
  • calcium acetate
  • mycophenolate mofetil
  • candesartan cilexetil
  • mycophenolic acid
  • candesartan cilexetil/hydrochlorothiazide
  • nabumetone
  • capecitabine
  • naproxen
  • capsaicin
  • niacin
  • captopril
  • nifedipine
  • carbamazepine
  • nilutamide
  • carbidopa/levodopa
  • nitroglycerin
  • carbidopa/levodopa/entacapone
  • norethindrone
  • carvedilol
  • norethindrone acetate
  • celecoxib
  • nortriptyline
  • cetirizine
  • nystatin
  • cevimeline
  • olanzapine
  • chlordiazepoxide
  • olmesartan medoxomil
  • chlorpromazine
  • olopatadine ophthalmic solution/drops
  • chlorthalidone
  • olopatadine spray; nasal
  • chlorzoxazone
  • omega-3-acid ethyl esters
  • cholestyramine
  • omeprazole
  • choline fenofibrate
  • ondansetron
  • cilostazol
  • oxandrolone
  • citalopram hydrobromide
  • oxcarbazepine
  • clindamycin
  • oxybutynin
  • clonazepam
  • oxybutynin chloride
  • clonidine
  • pantoprazole
  • clopidogrel bisulfate
  • paroxetine
  • clotrimazole/betamethasone
  • pentoxifylline
  • colestipol
  • perphenazine
  • cyclobenzaprine
  • phenelzine
  • darifenacin
  • phenobarbital/hyoscyamine/atropine-scopolamine hydrobromide
  • desvenlafaxine succinate
  • phenoxybenzamine
  • dexmethylphenidate
  • phenytoin sodium
  • dextroamphetamine sulfate
  • pioglitazone
  • dextroamphetamine/amphetamine
  • potassium chloride
  • diazepam
  • potassium citrate
  • diclofenac
  • potassium iodide
  • diclofenac sodium
  • pramipexole dihydrochloride
  • dicyclomine
  • pravastatin sodium
  • digoxin
  • prazosin
  • diltiazem
  • prednisone
  • diphenoxylate/atropine
  • prenatal multivitamin plus iron and folic acid
  • divalproex
  • primidone
  • divalproex sodium
  • prochlorperazine
  • donepezil
  • progesterone
  • dorzolamide
  • propafenone
  • dorzolamide/timolol maleate
  • propranolol
  • doxazosin
  • propylthiouracil
  • doxepin
  • pyridostigmine bromide
  • duloxetine
  • quetiapine fumarate
  • dutasteride
  • quinapril
  • eletriptan hydrobromide
  • rabeprazole sodium
  • enalapril maleate
  • raloxifene
  • enalapril maleate/hydrochlorothiazide
  • ramipril
  • epinephrine
  • ranitidine
  • eplerenone
  • rasagiline
  • escitalopram
  • repaglinide
  • esomeprazole
  • risedronate sodium
  • estradiol
  • risperidone
  • estropipate
  • rivastigmine
  • eszopiclone
  • ropinirole
  • ethinyl estradiol/norethindrone
  • rosuvastatin
  • ethinyl estradiol/norgestimate
  • rosuvastatin calcium
  • etodolac
  • sertraline
  • ezetimibe
  • sevelamer carbonate
  • famciclovir
  • sildenafil citrate
  • famotidine
  • sotalol
  • felodipine
  • spironolactone
  • fenofibrate
  • spironolactone/hydrochlorothiazide
  • ferrous sulfate
  • sucralfate
  • fexofenadine
  • sulfamethoxazole/trimethoprim
  • finasteride
  • sulfasalazine
  • flecainide acetate
  • sumatriptan
  • fluconazole
  • tacrolimus
  • fluoxetine
  • tamoxifen citrate
  • fluoxymesterone
  • tamsulosin
  • fluticasone propionate
  • telmisartan
  • fluticasone propionate/salmeterol
  • temazepam
  • fluticasone propionate/salmeterol xinafoate
  • terazosin
  • fluvoxamine maleate
  • testosterone
  • folic acid
  • testosterone cypionate
  • folic acid/vitamin B
  • tizanidine
  • furosemide
  • tolterodine tartrate
  • gabapentin
  • topiramate
  • gemfibrozil
  • tramadol
  • glimepiride
  • tramadol/acetaminophen
  • glipizide
  • trazodone
  • glucose meter blood glucose monitoring system
  • triamcinolone
  • glucose test strip blood glucose test strip; no coding
  • triamterene
  • glyburide
  • trifluoperazine
  • glyburide/metformin
  • trospium chloride
  • guanfacine
  • valacyclovir
  • halobetasol propionate
  • valproic acid
  • haloperidol
  • valsartan
  • hydralazine
  • valsartan/hydrochlorothiazide
  • hydrochlorothiazide
  • venlafaxine
  • hydrochlorothiazide/lisinopril
  • verapamil
  • hydrochlorothiazide/losartan
  • vitamin B complex
  • hydrochlorothiazide/olmesartan medoxomil
  • vitamin B-6
  • hydrochlorothiazide/quinapril
  • vitamin D3
  • hydrochlorothiazide/triamterene
  • warfarin
  • hydrocortisone
  • warfarin sodium
  • hydroxychloroquine
  • zafirlukast
  • hydroxyurea
  • zaleplon
  • hydroxyzine
  • zidovudine
  • ibuprofen
  • ziprasidone
  • indapamide
  • zolpidem tartrate
  • insulin syringe
  • zonisamide
 

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 March 27, 2018