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

AbbVie Patient Assistance Program Foundation

This program provides brand name medications at no or low cost

Provided by: AbbVie

PO Box 270
Somerville, NJ 08876

TEL: 800-222-6885


FAX: 866-898-1473
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

AbbVie Patient Assistance Foundation Application

 

Brand Name Medications Covered

 
  • Gengraf capsule
  • Synthroid
 

Generic Name

 
  • cyclosporine capsule
  • levothyroxine
 

Eligibility Requirements   

Insurance Status May have private insurance; must not be government funded
Those with Part D Eligible? Must've been denied LIS. Mustn't be eligible for Medicaid
Income Based on FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call or download
Receiving Faxed, emailed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign and provide annual income information. Proof of income required
Decision Communicated Patient and Doctor are notified
Decision Timeframe 5-7 business days
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 7-10 business days
Refill Process Patient or Doctor must contact company
Limit Not specified
Re-application New application yearly
   

Additional Information

Those with insurance may be eligible on an exception basis.


Updated July 12, 2017