NeedyMeds

This program provides brand name medications at no or low cost.

Provided by:

c/o Health Bridge Inc. (An Express-Scripts Inc. Company) PO Box 66745 St. Louis, MO 63166-6745 TEL: 800-556-8317 ALT PHONE: FAX: 866-851-2827	Program Website

	Languages Spoken: English, Others By Translation Service

Patient assistance
applications

Combivent Inhalation Aerosol 14.7gm (ipratropium bromide/albuterol sulfate)

Insurance Status	Must have no prescription coverage for needed medication
Those with Part D Eligible?	No, must be ineligible
Income	At or below 200% of FPL
Diagnosis/Medical Criteria	Not specified
US Residency Required?	Must be citizen or legal resident

Obtaining	Call or download
Receiving	Faxed, mailed or downloaded from website
Returning	Mail or fax
Doctor's Action	Complete section, sign, attach prescription
Applicant's Action	Complete, sign, attach proof of income and other requested documenation
Decision Communicated	Not specified
Decision Timeframe	Not specified

Amount/Supply	Up to 90 day supply
Sent To	Patient's home, unless otherwise noted
Delivery Time	Not specified
Refill Process	Doctor/doctor's office must contact company
Limit	Not applicable
Re-application	New application yearly

Eligibility determined on a case-by-case basis.

For Pradaxa and Tradjenta, patient must have an annual household income of up to 300% of the FPL.