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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Purdue Pharma |
| Program Name |
Purdue Pharma Patient Assistance Program |
| Program Address |
PO Box 66547
St Louis, MO 63166-6547
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| Phone Number |
800-599-6070
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| Fax Number |
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| Medications on Program |
Oxycontin Tablets 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg (oxycodone)
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| Application Forms |
Not Applicable |
On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient can have no public or private prescription insurance and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Those who are eligible for public prescription insurance even though not enrolled are not eligible for this program.
There is also a co-pay of $25 for each prescription that must be sent in as a money order.
Any patient who is denied assistance can appeal the decision by resending the application with a letter of explanation. This includes patients with insurance, patients in a gap, people who are eligible for Medicare Part D but did not enroll and patients who are in the Medicare Part D Donut Hole.
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| Application Process |
The doctor/doctor's office should call for an application. The application is faxed to the doctor's office. The completed application must be mailed back.
The patient is notified of eligibility for the program. Allow 2 weeks for processing and delivery of medication.
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| 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 and proof of residency.
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| Program Details |
Up to a 30-day supply is sent to the patient's home. A new prescription is needed for each refill. Once a year a new application with financial documentation is needed.
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| Last Updated |
October 22, 2009 |
