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

Program 1 of 3   Scroll down to see them all.  Updated June 12, 2013 Back | Print Page

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

Valeant Patient Assistance Program

Provided by:


Valeant Pharmaceuticals, Inc.
P.O. Box 836
Somervile, NJ 08876


TEL: 866-268-7325


ALT PHONE:
FAX: 866-217-7164
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

  • Zovirax  Cream  (acyclovir)
  • Zovirax  Ointment  (acyclovir)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must be citizen or legal resident
Obtaining Call
Receiving Faxed or mailed
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign
Decision Communicated If accepted, medication sent to Dr office. If denied, Dr office is informed
Decision Timeframe Within 2-3 days
Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Copy of application with new doctor signature
Limit Not specified
Re-application New application yearly

Additional Information:

Wellbutrin XL IS NOT AVAILABLE FOR NEW PATIENTS.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 3   Scroll down to see them all.  Updated May 31, 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

  • Zovirax  Capsule 200mg (acyclovir)
  • Zovirax  Tablet 400mg, 800mg (acyclovir)

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 3 of 3.  Updated February 01, 2013 Back | Print Page

This program provides generic medications at a discount.

Xubex Patient Assistance Program

Provided by:


Xubex
PO Box 1244
Winter Park, Fl 32790-1244

TEL: 866-699-8239


ALT PHONE: 407-478-2663
FAX: 407-671-7960
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Zovirax Capsule 200mg (acyclovir)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income No limits
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
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
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. There are fees for the medications:$20-$45 for a 90 day supply. ($40 or $60 for a 180 day supply and $80 or $120 for a 360 day supply.) Check the website for the exact price. A shipping and ordering fee of $3.85 is charged for each order. Requests may be expedited by having the physician fax the completed form to the Xubex pharmacy.



Read our privacy policy.

Copyright ©2013 by NeedyMeds, Inc.
Contents may not be reproduced in any form except for personal use
and may not be used on any other website without permission.

NeedyMeds, a registered 501(c)(3) national nonprofit (#75-2982493), makes every effort
to ensure the accuracy of the information on the website.
However, we can't guarantee the accuracy or completeness of the information.
Always check with the individual program if you have questions.