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

Program 1 of 4   Scroll down to see them all.  Updated May 02, 2013 Back | Print Page

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

Bridges to Access

Provided by:


GlaxoSmithKline
PO Box 29038
Phoenix, AZ 85038-9038

TEL: 866-728-4368


ALT PHONE:
FAX: 1-855-474-3063
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Imitrex Nasal Spray 5mg/unit, 20mg/unit (sumatriptan nasal)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income At or below 250% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Yes
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office or advocate
Doctor's Action Fax in prescription
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified in writing
Decision Timeframe Within 2-3 days
Amount/Supply Up to 90 day supply
Sent To Patient's home, doctor's office, hospital or pharmacy
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application New application yearly

Additional Information:

Prescription must come directly from the doctor’s office

Patients may apply on their own. Advocates must call to enroll Bridges to Access applicants who need immediate access to medicine (please see web page http://www.bridgestoaccess.com/ for further details about the two methods of enrollment).
The application can be filled out and printed from the website, but each application need an individual number (which the website does automatically.)
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 4   Scroll down to see them all.  Updated May 02, 2013 Back | Print Page

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

GSK Access

Provided by:


GlaxoSmithKline
PO Box 52046
Phoenix, AZ 85072-2046

TEL: 866-518-4357


ALT PHONE:
FAX: 866-518-3994
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Imitrex Nasal Spray 5mg/unit, 25mg/unit (sumatriptan nasal)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have Medicare Part D
Those with Part D Eligible? Yes, with proof of spending $600 on prescription drugs in current calendar year
Income At or below 250% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Patient notified in writing
Decision Timeframe Within 2-3 days
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 New application yearly

Additional Information:

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

Program 3 of 4   Scroll down to see them all.  Updated February 15, 2013 Back | Print Page

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

Rx Outreach Medications

Provided by:


Rx Outreach
PO Box 66536
St Louis, MO 63166-6536

TEL: 800-769-3880


ALT PHONE:
FAX: 800-875-6591
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Imitrex  25mg, 50mg, 100mg (sumatriptan succ)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
Obtaining Call, download or apply online
Receiving Faxed or mailed
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Usually same day
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly

Additional Information:

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the website for the exact price.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 4 of 4.  Updated January 14, 2013 Back | Print Page

This is a discount card program.

Together Rx Access

Provided by:


Together Rx Access, LLC
One Outlet Lane
Bald Eagle Court
Lock Haven, PA 17745

TEL: 800-444-4106


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

Imitrex Nasal Spray 5mg/unit, 20mg/unit, 25mg/unit (sumatriptan nasal)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No, must be ineligible
Income At or below $45,000 if single, $60,000 for family of 2, $75000 for 3, $90,000 for4, $105,000 for 5
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Enroll online
Receiving Downloaded from website
Returning Mail
Doctor's Action Not applicable
Applicant's Action If eligible, respond to 4 questions to enroll
Decision Communicated Patient notified
Decision Timeframe Not applicable
Amount/Supply Not applicable
Sent To Patient sent savings card to be used at pharmacy
Delivery Time Not applicable
Refill Process Not applicable
Limit Not applicable
Re-application Not applicable

Additional Information:

The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications.

Call for most recent medications as the list is subject to change.



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