| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 2. Scroll down to see them all. |
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Diflucan |
View Coupon |
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Rx Outreach MedicationsThis program provides medication at low cost. (Most brand names are provided for reference purposes only) |
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Provided by: Rx Outreach |
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PO Box 66536 TEL: 888-796-1234FAX: 800-875-6591 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Rx Outreach Application |
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Rx Outreach Diabetic Supplies Order Form (Prodigy) |
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Rx Outreach Refills and New Prescription Form |
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Rx Outreach Medication List |
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Rx Outreach Medication List (Spanish) |
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Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | ||
| Those with Part D Eligible? | Yes | ||
| Income | At or below 300% of FPL | ||
| Diagnosis/Medical Criteria | Not required | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call, download or apply online | ||
| Receiving | Faxed, mailed or downloaded from website | ||
| Returning | Fax or E-Prescribe online | ||
| Doctor's Action | Give prescription to patient | ||
| Applicant's Action | Complete section and sign | ||
| Decision Communicated | Medications sent if accepted. If denied patient and doctor notified | ||
| Decision Timeframe | Usually same day | ||
Medication |
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| Amount/Supply | Varies | ||
| Sent To | Doctor's office or patient's home | ||
| Delivery Time | Not specified | ||
| Refill Process | Company contacts patient to arrange | ||
| Limit | Only limited by manufacturer's guidelines | ||
| Re-application | New application yearly | ||
Additional Information |
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| Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s). |
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| Updated June 27, 2017 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 2. | |||
Diflucan |
View Coupon |
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Pfizer Savings Program |
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Provided by: Pfizer, Inc. |
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PO Box 66585 TEL: 866-706-2400FAX: 866-470-1748 |
Languages Spoken:
English |
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Program Applications and Forms |
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Pfizer Savings Program Medication List |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must be uninsured | ||
| Those with Part D Eligible? | No | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
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| Obtaining | Call for prescreening | ||
| Receiving | There is no application | ||
| Returning | Not applicable | ||
| Doctor's Action | Give prescription to patient | ||
| Applicant's Action | Call to enroll | ||
| Decision Communicated | Decision made during phone screening | ||
| Decision Timeframe | Decision made during phone screening | ||
Medication |
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| Amount/Supply | Contact the program for more details. | ||
| Sent To | Pharmacy | ||
| Delivery Time | Not applicable | ||
| Refill Process | Varies per medication | ||
| Limit | None | ||
| Re-application | New enrollment every 12 months | ||
Additional Information |
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| This program provides uninsured patients with savings on their prescriptions at the pharmacy. Pfizer also has programs that provide eligible patients with insurance support, copay assistance, and medicines for free. Contact Pfizer RxPathways for details (844-989-7284) |
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| Updated June 13, 2017 | |||
