Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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Updated September 25, 2014
 

Forteo

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Forteo Patient Assistance Program

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

Provided by: Eli Lilly & Company

PO Box 66746
St Louis, MO 63166-6746

TEL: 877-214-3475


ALT PHONE:
FAX: 888-453-7801
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Forteo Patient Assistance Program Application

 

Medications

  • Forteo Injectable; Subcutaneous dosage varies (teriparatide)
 

Eligibility Requirements   

Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
Those with Part D Eligible? No, must be ineligible
Income At or below 300% of FPL
Diagnosis/Medical Criteria Must be under 65 years of age
US Residency Required? Must be US citizen or permanent resident
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach proof of income and other requested documentation
Decision Communicated Patient notified
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home
Delivery Time Within 10-14 days
Refill Process Patient must contact company
Limit Lifetime limit of 24 months
Re-application Company contacts patient about reapplying
   

Additional Information

Needles require a prescription and alcohol swabs will be provided with supply kit.

Contact program for Spanish application.


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 4.
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Updated September 11, 2014
 

Forteo

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LillyMedicareAnswers Program

This program only helps people enrolled in Medicare Part D.

Provided by: Eli Lilly & Company

PO Box 66977
St. Louis, Missouri 63166-6747

TEL: 877-795-4559


ALT PHONE:
FAX: 800-692-0331
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

LillyMedicareAnswers Patient Assistance Program Application

 

Medications

  • Forteo Injectable; Subcutaneous dosage varies (teriparatide)
 

Eligibility Requirements   

Insurance Status Must be enrolled in a Medicare Part D prescription plan
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 Not disclosed
US Residency Required? United States or Puerto Rico
   

Application

Obtaining Call or download
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach copy of Medicare Part D card, proof of income and low-income subsidy denial
Decision Communicated Patient notified
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application Must re-enroll at end of calendar year
   

Additional Information

For the medication Forteo, this is one-time program and maximum enrollment is for 2 years. Patient must reapply every year.

You must have been denied low-income subsidy and are not enrolled in Medicaid.


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 4.
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Updated October 23, 2014
 

Forteo

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Diplomat's Co-Pay Assistance Navigator Program

This is a copay assistance program.

Provided by: Diplomat Specialty Pharmacy

ATTN: FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


ALT PHONE:
FAX: 810-282-0176
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Diplomat Request of Financial Assistance Form

 

Medications

  • Forteo Injection dosage varies (teriparatide (rDNA) human)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Fax or mail
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign and provide annual income information. Proof of income may be request by program at any time
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Within 1-2 business days
   

Medication

Amount/Supply Amount requested is sent
Sent To Patient's home
Delivery Time Once approved; within 2 business days
Refill Process Company contacts patient to arrange
Limit Varies per medication
Re-application Determined case by case
   

Additional Information

Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie



Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 4. Updated October 17, 2014
 

Forteo

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Patient Access Network Foundation (PAN)

This is a copay assistance program.

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


ALT PHONE:
FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • Forteo Injectable; Subcutaneous dosage varies (teriparatide)
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Determined case by case
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.