| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Updated January 29, 2015 | |||
Diflucan |
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Rx Outreach MedicationsThis program provides medication at low cost. |
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Provided by: Rx Outreach |
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PO Box 66536 TEL: 888-796-1234ALT PHONE: FAX: 800-875-6591 |
Languages Spoken:
English, Spanish |
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Patient Assistance Applications |
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Rx Outreach Application |
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Rx Outreach Diabetic Supplies |
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Rx Outreach Refills and New Prescriptions Order Form |
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Rx Outreach Medication List |
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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 or mailed | ||
| 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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