Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated October 15, 2014
 

Edarbi

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Arbor Patient Assistance Program

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

Provided by: Arbor Pharmaceuticals, LLC.

951 Clint Moore Road
Suite A
Boca Raton, FL 33487

TEL: 888-417-7153


ALT PHONE:
FAX: 407-641-9566
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Arbor Patient Assistance Program Application

 

Medications

  • Edarbi Tablet 40mg, 80mg (azilsartan medoxomil)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but have been denied or are ineligible for Low Income Subsidy
Income At or below 300% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and include Medicaid denial letter
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Patient must contact company
Limit None
Re-application New application yearly
   

Additional Information

Must be at or below 300% FPL for BiDil.
Must be at or below 200% FPL for all other medications.