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Program 1 of 3 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company Medtronic, Inc.
Program Name ITB Therapy Patient Assistance Program
Program Address Medtronic ITB Therapy Patient Assistance Program
NORD
55 Kenosia Avenue
P.O. Box 1968
Danbury, CT 06813-1968
Phone Number

800-999-6673, opt 3, opt 1216

Fax Number 203-798-2964
Medications on Program Lioresal intrathecal 10mg/20ml, 10mg/5 ml, 0.05mg/1ml (baclofen 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

The patient must have no prescription coverage for the requested medication and meet income and other eligibility guidelines that are not disclosed. The patient must be diagnosed with Spasticity. The patient must also be a US resident or legal alien. A negative decision can be appealed. Patients may not be a Medicaid recipient nor covered under Medicare.

Application Process

Anyone with the patient's and the doctor's information can call. The application is sent to the doctor's office. The completed application can be faxed or mailed back.   The estimated timeline is 3-5 business days. 

Application Requirements

The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income.

Program Details

The medication is sent to the doctor's office. The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.

Last Updated August 27, 2009


                                         

Program 2 of 3 Scroll down to see them all.

This program provides generic medications at a discount.
Pharmaceutical Company Express Scripts Specialty Distribution Services
Program Name Rx Outreach Medications
Program Address PO Box 66536
St Louis, MO 63166-6536
Phone Number

800-769-3880

Fax Number Not Applicable
Medications on Program baclofen Tablet 10mg, 20mg (Lioresal)
Application Forms Rx Outreach
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

Applicants with insurance are eligible. have an income at or below 300% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This program is for generic medications only. Many medications are available for a fee of $20 for up to a 180 day supply. Prices vary for Tier 2 and Tier 3 medications. Please refer to the Rx Outreach website for more information.

Application Process

Anyone requesting assistance can call to request a faxed application or download it from the website. The application can be either faxed or mailed out upon request. The completed application must be mailed back.  The patient is notified of eligibility for the program.  

Application Requirements

The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.

Program Details

The medication is sent to either the doctor's office or the patient's home. The patient must contact the company to arrange for refills. Every year a new application is needed.

Last Updated September 22, 2009


                                         

Program 3 of 3.

This program provides generic medications at a discount.
Pharmaceutical Company Xubex Pharmaceuticals
Program Name Xubex Patient Assistance Program
Program Address PO Box 1244
Winter Park, Fl 32790-1244
Phone Number

866-699-8239

Fax Number 407-671-7960
Medications on Program baclofen Tablets 10mg, 20mg (Lioresal)
Application Forms Xubex Pharmaceutical Services
On-line Application
Link to online application
Web Site Click to go to program's web site
Eligibility Guidelines and Notes

Applicants with insurance are eligible. The patient must have an income at or below 243% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This is a program for generic medications only. There are fee for the medications either $20 or $30 for a 90 day supply. ($40 or $60 for a 180 day supply and $80 or $120 for a 360 day supply.)Xubex now offers a 30 day supply of some medications free of charge. Patients may apply online or print the prescription, complete and fax to the Xubex pharmacy for processing. Requests may be expedited by having the physician fax the completed form to the Xubex pharmacy.

Application Process

Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back.    The medication is shipped within 10 business days.

Application Requirements

The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.

Program Details

The medication is sent to either the doctor's office or the patient's home. The company automatically sends out refills. Once a year a new application with financial documentation is needed.

Last Updated August 14, 2009