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
  • Lotrel
  • Accolate
  • Lotrisone
  • Accupril
  • Lovaza
  • Accuretic
  • Lunesta
  • AcipHex
  • Maxzide
  • Aclovate
  • Mestinon
  • Actonel
  • Metadate CD
  • Actos
  • Micardis
  • Adderall XR
  • Microzide
  • Alaway
  • Minocin
  • Aldactone
  • Mirapex
  • Allegra
  • Mobic
  • Altace
  • Monoket
  • Amaryl
  • Mysoline
  • Ambien
  • Namenda
  • Ambien CR
  • Naprosyn
  • Androxy
  • Nardil
  • Antivert
  • Neurontin
  • Aricept
  • Nexium
  • Arimidex
  • Niacor
  • Astelin
  • Niaspan
  • Atacand
  • Nilandron
  • Atacand HCT
  • Nitrostat
  • Ativan
  • Norvasc
  • Avalide
  • Nyamyc
  • Avapro
  • Ogen
  • Avodart
  • Ortho Micronor
  • Azilect
  • Ortho Tri-Cyclen
  • Azor
  • Ortho-Cyclen
  • Azulfidine En-Tab
  • Ovcon 35
  • Bactrim
  • Oxandrin
  • Benicar
  • Pacerone
  • Benicar HCT
  • Pamelor
  • Bentyl
  • Panretin
  • Calan
  • Parafon Forte DSC
  • Calan SR
  • Parnate
  • Capoten
  • Paxil
  • Carafate
  • Pepcid
  • Cardizem CD
  • Phoslo
  • Cardura
  • Plaquenil
  • Casodex
  • Plavix
  • Catapres
  • Plendil
  • Catapres-TTS-3
  • Pletal
  • Celebrex
  • Prandin
  • Celexa
  • Pravachol
  • Cellcept
  • Prevacid
  • Claritin
  • Prevalite
  • Cleocin
  • Prilosec
  • Colazal
  • Prinivil
  • Colestid
  • Prinzide
  • Coreg
  • Pristiq
  • Cosopt
  • Proair Respiclick
  • Coumadin
  • Procardia XL
  • Cozaar
  • Prograf
  • Crestor
  • Proscar
  • Cymbalta
  • Protonix
  • Cytomel
  • Provera
  • Depakene
  • Provigil
  • Depakote
  • Prozac
  • Depakote ER
  • Pulmicort Respules
  • Depo-Testosterone
  • Qudexy XR
  • Detrol
  • Reglan
  • Dibenzyline
  • Remeron
  • 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
  • Enulose
  • Sorine
  • Epitol
  • SSKI
  • Estrace
  • Stalevo
  • 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
  • Fortical
  • Trusopt
  • Fosamax
  • Ultracet
  • Geodon
  • Ultram
  • Glucophage
  • Ultram ER
  • Glucophage XR
  • Ultravate
  • Glucotrol
  • Urecholine
  • Glucotrol XL
  • UroXatral
  • Glucovance
  • Valium
  • Glynase
  • Valtrex
  • Hexalen
  • Vaseretic
  • Hydrea
  • Vasotec
  • Hyzaar
  • Vogelxo
  • Imitrex
  • Voltaren XR
  • Imuran
  • Wellbutrin
  • Intuniv
  • Wellbutrin SR
  • Isoptin
  • Wellbutrin XL
  • Jantoven
  • Xalatan
  • Keppra
  • Xanax
  • Keppra XR
  • Xopenex
  • Klonopin
  • Xyzal
  • Lamictal
  • Zanaflex
  • Lanoxin
  • Zantac
  • Lasix
  • Zaroxolyn
  • Levoxyl
  • Zestoretic
  • Lexapro
  • Zestril
  • Lidoderm
  • Ziac
  • Lipitor
  • Zofran
  • Lithobid
  • Zofran ODT
  • Lofibra (Micronized)
  • Zoloft
  • Lomotil
  • Zonegran
  • Lonox
  • Zovirax
  • Lopid
  • Zyloprim
  • Lopressor
  • Zyprexa
  • Lotensin
  • Zyrtec
  • Lotensin HCT
 

Generic Name

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

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 June 27, 2017