Program

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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Bristol-Myers Squibb Company
Program Name	Bristol-Myers Squibb Patient Assistance Program for Abilify
Program Address	PO Box 8309 Somerville, NJ 08876
Phone Number	800-736-0003, opt 3
Fax Number	866-598-5561
Medications on Program	Abilify DISCMELT 10mg, 15mg (aripiprazole) Abilify Oral Solution 150ml (aripiprazole) Abilify Tablets 2mg, 5mg, 10mg, 15mg, 20mg, 30mg (aripiprazole)
Application Forms	Bristol Meyers Squibb Patient Assistance Program for Abilify
On-line Application	No on-line application available at this time
Web Site	No link available.
Eligibility Guidelines and Notes	The patient cannot have prescription insurance, be ineligible for any federal or state programs and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident. If a patient enrolls in Medicare Part D, then s/he is no longer eligible for this program. However they consider appeals. If the patient chooses not to to enroll in Part D then s/he is still eligible to be on this program.
Application Process	With the patient's permission, anyone concerned can call for an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back. Both the patient and doctor are notified in writing of acceptance or denial. The decision is usually made within 48 hours. The product is shipped out within 5-7 business days.
Application Requirements	The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income and denial letter from Medicaid.
Program Details	Up to a 90-day supply is sent to the doctor's office. The doctor/doctor's office must contact the company to arrange refills. Every year a new application is needed.
Last Updated	November 02, 2009

Program 2 of 2.

This is a discount card program.
Pharmaceutical Company	Together Rx Access
Program Name	Together Rx Access
Program Address	PO Box 9426 Wilmington, DE 19809-9944
Phone Number	800-444-4106
Fax Number
Medications on Program	Abilify Tablets 5mg, 10mg, 15mg, 20mg, 30mg (aripiprazole)
Application Forms	Together Rx Access
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must have no prescription coverage for any medications and have an income at or below $45000 if single, $60000 for a family of 2, $75000 for a family of 3, $90000 for a family of 4, $105000 for a family of 5 Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications. Each card holder's savings depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased.
Application Process	The patient can call to get an application, apply on line, or download the application.
Application Requirements	Not applicable.
Program Details	The patient is sent a Together Rx Access prescription savings card.
Last Updated	July 31, 2009