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This program only helps people enrolled in Medicare Part D.
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| Pharmaceutical Company |
Boehringer Ingelheim Pharmaceuticals, Inc. |
| Program Name |
Boehringer Ingelheim CARES Foundation Patient Assistance Program For Medicare Beneficiaries |
| Program Address |
c/o Health Bridge Inc.
(An Express-Scripts Inc. Company)
PO Box 66745
St. Louis, MO 63166-6745 |
| Phone Number |
800-556-8317
|
| Fax Number |
866-727-5891 |
| Medications on Program |
Flomax Capsules (tamsulosin)
|
| Application Forms |
Boehringer Ingelheim CARES Foundation Patient Assistance Program for Medicare Beneficiaries
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
Patients must be eligible for Medicare but may not have other prescription drug coverage (Medicaid.) The patient must also have an annual adjusted income between 135% and 200% of the FPL, for most medications. Patients prescribed medications for HIV or AIDS may have an annual household income of between 135% and 300% of the FPL. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident. Patients must have spent at least 3% of their annual household income on prescriptions during the current calendar year. An individual may not qualify if they have non-Medicare insurance that covers their prescription drugs, are eligible for Medicaid, and eligible for Medicare's Low Income Subsidies, also known as 'Extra Help.'
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| Application Process |
Anyone requesting assistance can call the above number to request an application be mailed or faxed out or download it from the website. The completed application can be faxed or mailed back.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient needs to complete an application, sign it, and attach proof of income and other requested documentation.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. The doctor/doctor's office must contact the company to arrange refills. The patient must reapply once a year.
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| Last Updated |
October 27, 2009 |
