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Updated March 11, 2014

Boehringer Ingelheim Cares Foundation Patient Assistance Program

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

Provided by: Boehringer Ingelheim Pharmaceuticals, Inc.

PO Box 66745
St. Louis, MO 63166-6745

TEL: 800-556-8317


ALT PHONE:
FAX: 866-851-2827
Languages Spoken:

English, Others By Translation Service

Program Website
 

Patient Assistance Applications

Boehringer Ingelheim Cares Foundation Application

Boehringer Ingelheim Cares Foundation Application (Spanish)

HIV Common Application

 

Medications

  • dabigatran etexilate Capsule 75mg, 150mg (Pradaxa)
 

Eligibility Requirements

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes, but contact program for details
Income Based on FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete, sign, attach proof of income and other requested documenation
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient or Doctor's office needs to contact company
Limit Not applicable
Re-application New application yearly
   

Additional Information

Eligibility determined on a case-by-case basis:
Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.

For Pradaxa and Tradjenta, patient must have an annual household income of up to 300% of the FPL.