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


Xubex Patient Assistance Program

This program provides medication at low cost. (Most brand names are provided for reference purposes only)

Provided by: Xubex

PO Box 1244
Winter Park, Fl 32790-1244

TEL: 866-699-8239

ALT PHONE: 407-478-2663
FAX: 407-671-7960
Languages Spoken:


Program Website


Program Applications and Forms

Xubex Patient Assistance Program Registration Form (pages 1 & 2)

Xubex Patient Assistance Program Physician Order Sheet (page 3)



  • Lotemax (loteprednol etabonate)

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes, but contact program for details
Income No limits
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes


Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Not specified
Decision Timeframe Not specified


Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Within 10 days
Refill Process Automatically sent out
Limit Varies per medication
Re-application New application, new documentation yearly

Additional Information

No proof of income is required. Check the website for the exact price.

This service is not currently available in Montana.

Updated October 31, 2016