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	Merck & Company , Inc.
Program Name	Merck Patient Assistance Program
Program Address	PO Box 690 Horsham, PA 19044-9979
Phone Number	800-727-5400
Fax Number
Medications on Program	Cipro Oral Solution 250mg, 500mg (ciprofloxacin) Cipro Tablets 250mg, 500mg (ciprofloxacin)
Application Forms	Merck Patient Assistance Program Merck Patient Assitance Program (Spanish Application)
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 the requested medication and and have an income at or below 400% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Anyone in need should apply because they do make exceptions for people truly in need. The program speaks both Spanish and English. Medicare D partipants may be eligible through an appeals process.
Application Process	Anyone requesting assistance can call to get an enrollment form sent out, or download it from the website. The application is sent to either the doctor or the patient. The completed application must be mailed back. Doctor or patient needs to call to find out about acceptance/denial. No letter is sent out.
Application Requirements	The doctor must fill out a section and sign the application. The patient must fill out a section and sign the application.
Program Details	Up to a 90-day supply is sent to the doctor's office or the patient's home. The patient or doctor must contact the company for refills. Every year a new application is needed.
Last Updated	August 16, 2010

Program 2 of 2.

This program provides generic medications at a discount.
Pharmaceutical Company	Xubex Pharmaceuticals
Program Name	Xubex Patient Assistance Program
Program Address	PO Box 1244 Winter Park, Fl 32790-1244
Phone Number	866-699-8239
Fax Number	407-671-7960
Medications on Program	ciprofloxacin Tablets 250mg, 500mg, 750mg (Cipro)
Application Forms	Xubex Patient Assistance Program
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	Applicants with insurance are eligible. This program does not have income limitations. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This is a program for generic medications only. There are fees for the medications:$20-$45 for a 90 day supply. ($40 or $60 for a 180 day supply and $80 or $120 for a 360 day supply.) Check the website for the exact price. A shipping and ordering fee of $3.85 is charged for each order. Patients may apply online or print the prescription, complete and fax to the Xubex pharmacy for processing. Requests may be expedited by having the physician fax the completed form to the Xubex pharmacy.
Application Process	Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back. The medication is shipped within 10 business days.
Application Requirements	The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Program Details	The medication is sent to either the doctor's office or the patient's home. The company automatically sends out refills. Once a year a new application with financial documentation is needed.
Last Updated	August 04, 2010