800-556-8317

To qualify the patient must be ineligible for prescription drug assistance through Medicaid, Medicare and may not have other prescription coverage. The patient must meet the required income guideline of 200% of the FPL. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident. All requests are reviewed on a case-by-case basis.

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.    

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.

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.

800-556-8317

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.'

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.    

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.

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.

866-699-8239

 This program does not have income limitations. Medical diagnosis is not necessary This program is not valid in Massachusetts, so MA residents are not eligible. This is a copay assistance program that covers all or part of the applicant's copay for the medication. The amount of the copay assistance varies by medication, check the program's website for the exact amount. The application does not require a HCP signature, however the applicant must send the prescription(s) in with the application.

Anyone requesting assistance can call the above number to request an application be mailed or faxed out or download it from the website. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.    

Not applicable.

The medication is sent to the patient's home.