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

Rx Outreach Medication List (Spanish)

 

Brand Name Medications Covered

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

Generic Name

 
  • acyclovir
  • labetalol
  • albuterol
  • lactulose
  • alclometasone dipropionate
  • lamotrigine
  • alendronate sodium
  • lansoprazole
  • alfuzosin
  • latanoprost
  • alitretinoin
  • letrozole
  • allopurinol
  • levalbuterol
  • alprazolam
  • levetiracetam
  • altretamine
  • levocetirizine
  • amantadine
  • levothyroxine
  • amiodarone
  • lidocaine
  • amitriptyline
  • liothyronine sodium
  • amlodipine
  • lisinopril
  • amlodipine besylate
  • lisinopril/hydrochlorothiazide
  • amlodipine besylate/benazepril
  • lithium carbonate
  • amlodipine besylate/valsartan
  • loperamide
  • amlodipine besylate/valsartan/hydrochlorothiazide
  • loratadine
  • amoxapine
  • lorazepam
  • anastrozole
  • losartan
  • aripiprazole
  • lovastatin
  • aspirin
  • loxapine succinate
  • atenolol
  • magnesium oxide
  • atenolol/chlorthalidone
  • meclizine
  • atorvastatin calcium
  • medroxyprogesterone acetate
  • atropine/diphenoxylate
  • meloxicam
  • azathioprine
  • memantine
  • azelastine
  • metformin
  • baclofen
  • methimazole
  • balsalazide disodium
  • methocarbamol
  • belladonna alkaloids/phenobarbital syrup
  • methotrexate
  • benazepril
  • methylphenidate
  • benazepril/hydrochlorothiazide
  • metoclopramide
  • benzonatate
  • metolazone
  • benztropine
  • metoprolol succinate/hydrochlorothiazide
  • betamethasone dipropionate
  • metoprolol sussinate
  • bethanechol
  • metoprolol tartrate
  • bicalutamide
  • midodrine
  • bisoprolol fumarate/hydrochlorothiazide
  • minocycline
  • brimonidine tartrate
  • mirtazapine
  • bromocriptine
  • modafinil
  • budesonide
  • mometasone furoate
  • bupropion
  • montelukast sodium
  • buspirone
  • mycophenolate mofetil
  • calcitonin salmon (rDNA origin)
  • nabumetone
  • calcitriol
  • naproxen
  • calcium acetate
  • naproxen sodium
  • candesartan cilexetil
  • niacin
  • candesartan cilexetil/hydrochlorothiazide
  • nifedipine
  • capsaicin
  • nilutamide
  • captopril
  • nitroglycerin
  • carbamazepine
  • norethindrone
  • carbidopa/levodopa
  • norethindrone acetate
  • carbidopa/levodopa/entacapone
  • nortriptyline
  • carvedilol
  • nystatin
  • celecoxib
  • olanzapine
  • cetirizine
  • omega-3-acid ethyl esters
  • cevimeline
  • omeprazole
  • chlordiazepoxide
  • ondansetron
  • chlorpromazine
  • oxandrolone
  • chlorthalidone
  • oxcarbazepine
  • chlorzoxazone
  • oxybutynin
  • cholestyramine
  • oxybutynin chloride
  • choline fenofibrate
  • pantoprazole
  • cilostazol
  • paroxetine
  • citalopram hydrobromide
  • pentoxifylline
  • clindamycin
  • perphenazine
  • clonazepam
  • phenelzine
  • clonidine
  • phenobarbital/hyoscyamine/atropine-scopolamine hydrobromide
  • clopidogrel bisulfate
  • phenoxybenzamine
  • clotrimazole/betamethasone
  • phenytoin sodium
  • colestipol
  • pioglitazone
  • cyclobenzaprine
  • potassium chloride
  • dexmethylphenidate
  • potassium citrate
  • dextroamphetamine sulfate
  • potassium iodide
  • dextroamphetamine/amphetamine
  • pramipexole dihydrochloride
  • diazepam
  • pravastatin sodium
  • diclofenac
  • prazosin
  • diclofenac sodium
  • prednisone
  • dicyclomine
  • prenatal multivitamin plus iron and folic acid
  • digoxin
  • primidone
  • diltiazem
  • prochlorperazine
  • diphenoxylate/atropine
  • progesterone
  • divalproex
  • propafenone
  • divalproex sodium
  • propranolol
  • donepezil
  • propylthiouracil
  • dorzolamide
  • pyridostigmine bromide
  • dorzolamide/timolol maleate
  • quetiapine fumarate
  • doxazosin
  • quinapril
  • doxepin
  • rabeprazole sodium
  • duloxetine
  • raloxifene
  • dutasteride
  • ramipril
  • enalapril maleate
  • ranitidine
  • enalapril maleate/hydrochlorothiazide
  • repaglinide
  • epinephrine
  • risedronate sodium
  • eplerenone
  • risperidone
  • escitalopram
  • rivastigmine
  • esomeprazole
  • ropinirole
  • estradiol
  • rosuvastatin
  • estropipate
  • rosuvastatin calcium
  • eszopiclone
  • rufinamide oral suspension
  • ethinyl estradiol/norethindrone
  • rufinamide tablet
  • ethinyl estradiol/norgestimate
  • sertraline
  • etodolac
  • sildenafil citrate
  • famciclovir
  • simvastatin
  • 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
  • fluvoxamine maleate
  • temazepam
  • folic acid
  • terazosin
  • folic acid/vitamin B
  • testosterone
  • furosemide
  • testosterone cypionate
  • gabapentin
  • tizanidine
  • gemfibrozil
  • tolterodine tartrate
  • glimepiride
  • topiramate
  • glipizide
  • tramadol
  • glucose meter blood glucose monitoring system
  • tramadol/acetaminophen
  • glucose test strip blood glucose test strip; no coding
  • trandolapril
  • glyburide
  • tranylcypromine
  • glyburide/metformin
  • trazodone
  • guanfacine
  • triamcinolone
  • halobetasol propionate
  • triamterene
  • haloperidol
  • trifluoperazine
  • hydralazine
  • trospium chloride
  • hydrochlorothiazide
  • valacyclovir
  • hydrochlorothiazide/lisinopril
  • valproic acid
  • hydrochlorothiazide/losartan
  • valsartan
  • hydrochlorothiazide/quinapril
  • valsartan/hydrochlorothiazide
  • hydrochlorothiazide/triamterene
  • venlafaxine
  • hydrocortisone
  • verapamil
  • hydroxychloroquine
  • vitamin B complex
  • hydroxyurea
  • vitamin B-6
  • hydroxyzine
  • vitamin D3
  • ibuprofen
  • warfarin
  • indapamide
  • warfarin sodium
  • insulin syringe
  • zafirlukast
  • ipratropium bromide-albuterol
  • zaleplon
  • irbesartan
  • zidovudine
  • irbesartan/hydrochlorothiazide
  • ziprasidone
  • isosorbide mononitrate
  • zolpidem tartrate
  • ketotifen fumarate
  • 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 November 15, 2016