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The patient cannot have prescription insurance, be ineligible for any federal or state programs and the patient must also also have limited financial resources. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident.  Eligibility is determined on a case by case basis. Any patient who is enrolled in any Government Prescription Programs or Private Prescription Plans including, but not limited to Medicare Part D, Medicaid, State-sponsored Prescription Assistance programs, or has employee, military, retirement, or pension program drug coverage is not eligible for this program. Pharmacy discount cards or other patient assistance programs are not considered coverage.

The patient or doctor should call for an application. The application is sent to the doctor's office. The completed application can be faxed or mailed back.  The doctor is notified by mail of acceptance or denial.  The medication is usually shipped within 7-10 business days.

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.

Up to a 90-day supply is sent to the doctor's office. The doctor/doctor's office must fill out a replacement form to get refills. Once a year a new application with financial documentation is needed.