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

Arbor Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Arbor Pharmaceuticals, LLC.

PO Box 6123
Lawrenceville, NJ 08648

TEL: 844-884-8700


FAX: 844-287-5417
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Arbor Patient Assistance Program Application

 

Brand Name Medications Covered

 
  • BiDil tablet
  • EryPed granule; oral
  • E.E.S. granule; oral
  • Horizant
  • Edarbi tablet
  • PCE
  • Edarbyclor tablet
  • Sotylize oral solution
  • ERY-TAB
 

Generic Name

 
  • azilsartan kamedoxomil/chlorthalidone tablet
  • erythromycin tablet
  • azilsartan medoxomil tablet
  • gabapentin enacarbil
  • erythromycin
  • isosorbide dinitrate/hydralazine tablet
  • erythromycin ethylsuccinate granule; oral
  • sotalol oral solution
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but have been denied or are ineligible for Low Income Subsidy
Income Varies. **See below for details
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 4 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Patient must contact company
Limit None
Re-application New application yearly
   

Additional Information

Must be at or below 300% FPL for BiDil.
Must be at or below 200% FPL for all other medications.


Updated June 22, 2017