NeedyMeds

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

SUPPORT Program for Crixivan

Provided by:

Merck & Company, Inc.

SUPPORT Program PO Box 305 San Bruno,CA 94066 TEL: 800-850-3430 ALT PHONE: FAX: 866-410-1913	Program Website

	Languages Spoken: English

Patient assistance
applications

Medications

Crixivan Capsule 100mg, 200mg 333mg, 400mg (indinavir)

Eligibility Requirements

APPLICATION

MEDICATION

Insurance Status	May have insurance
Those with Part D Eligible?	Considered on exception basis
Income	At or below 500% of FPL
Diagnosis/Medical Criteria	Not specified
US Residency Required?	Must live in the US and have prescription from US licensed doctor

Obtaining	Call or download
Receiving	Sent to doctor or patient
Returning	Mail
Doctor's Action	Complete section, sign
Applicant's Action	Complete section, sign
Decision Communicated	Patient and Doctor are notified
Decision Timeframe	2-4 business days

Amount/Supply	Varies
Sent To	Doctor's office, pharmacy or patient's home
Delivery Time	Within 10 days
Refill Process	Automatically sent out
Limit	Not specified
Re-application	New application yearly

Additional Information:

Insurance benefits, claims assistance and/or other reimbursement help is offered. Exceptions to guidelines considered.

This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs.

IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.