Program

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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	Eli Lilly & Company
Program Name	Lilly Cares Foundation Patient Assistance Program
Program Address	Lilly Cares Program PO Box 230999 Centerville, VA 20120
Phone Number	800-545-6962 800-488-2133
Fax Number	703-310-2534
Medications on Program	Prozac Pulvules 10mg, 20mg, 40mg (fluoxetine)
Application Forms	Lilly Cares Patient Assistance Program
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 can have no public or private prescription insurance and have an income at or below 300% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Patients who are eligible for any government program, including Part D, are not eligible for this program.
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. Allow 4 weeks for processing and delivery of medication.
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.
Program Details	Up to a 120-day supply is sent to the doctor's office. A refill/reorder form is included with each shipment that must be filled out and returned to get the next shipment. Once a year a new application with financial documentation is needed.
Last Updated	October 02, 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	fluoxetine Tablets 10mg, 20mg, 40mg (Prozac)
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	fluoxetine Tablets 10mg, 20mg (Prozac)
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