Program

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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Abbott
Program Name	Abbott Patient Assistance Foundation (HUMIRA)
Program Address	PO Box 789 San Bruno, CA 94066
Phone Number	800-222-6885
Fax Number	866-250-2803
Medications on Program	Humira Injection (adalimumab)
Application Forms	Abbott Patient Assistance Foundation (HUMIRA)
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must not have any private nor public insurance and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. Patients with prescription drug coverage, including enrollment in a Medicare Part D Prescription Drug Plan, who have difficulty accessing their Abbott medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program exception based on health-related expenditures and household income.
Application Process	The patient or doctor should call for an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back. Both the patient and doctor are notified of acceptance into the program. The decision is usually made within 24-48 hours. The medication is shipped within 3-5 business days.
Application Requirements	The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Program Details	Up to a 90-day supply is sent to the doctor's office or the patient's home. The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.
Last Updated	August 13, 2009

Program 2 of 2.

This program provides help in applying for assistance with the cost of this drug.
Pharmaceutical Company	Diplomat Specialty Pharmacy
Program Name	Diplomat's Co-Pay Assistance Navigator Program
Program Address	Attn: Funding Department 2029 S. Elms Rd., Suite D, Swartz Creek, MI 48473
Phone Number	877-977-9118 ext. 10184
Fax Number	866-418-2650
Medications on Program	Humira Injection (adalimumab) Humira injection (adalimumab injection)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Individual eligibility and level of financial support is determined on a case by case basis. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The Co-Pay Navigator is a full service program to help patients seek funding assistance for the co-pay portion of their required medications. There is no charge for this service. Physicians/physicians' offices may submit an application online at the website indicated above, or fax information as directed below.
Application Process	The physician/physician's office should fax the prescription, diagnosis, patient demographics and any insurance information to 866-418-2650 Attn: Sandy/Funding. A Patient Care Coordinator will contact the patient within 24-48 business hours.
Application Requirements	Will be discussed with the patient and physician after the initial request to the program is received.
Program Details	Not applicable.
Last Updated	August 05, 2009