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

Akrimax Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Akrimax Pharmaceuticals

PO Box 31035
Charlotte, NC 28231

TEL: 855-856-6915

FAX: 919-443-1483
Languages Spoken:

English, Spanish

Program Website


Patient Assistance Applications

Akrimax Patient Assistance Program Enrollment Form: Contact program


Brand Name Medications Covered

  • Primlev tablet
  • Tirosint

Generic Name

  • levothyroxine
  • oxycodone and acetaminophen tablet

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Yes


Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription and include a cover page with contact info, medical provider address, DEA number and patient name
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Not specified
Decision Timeframe Not specified


Amount/Supply Up to 30 day supply
Sent To Doctor's office or patient's home
Delivery Time Within 2 weeks
Refill Process PAP support line
Limit Varies per medication
Re-application New application yearly

Additional Information

Updated December 26, 2017