Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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Updated September 18, 2014
 

Pfizer RxPathways Patient Assistance Program

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

Provided by: Pfizer, Inc.

PO Box 66585
St. Louis, MO 63166-6585

TEL: 866-706-2400


ALT PHONE:
FAX: 866-470-1748
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Pfizer Group A Application for Primary Care medicines

Pfizer Group A Application for Primary Care medicines (Spanish)

Pfizer Group B Application for Oncology and Specialty medicines

Pfizer Group B Application for Oncology and Specialty medicines (Spanish)

Pfizer Group C Application for Vaccines

Pfizer Group C Application for Vaccines (Spanish)

 

Medications

  • hydrocortisone Tablet dosage varies (Cortef)
 

Eligibility Requirements   

Insurance Status Uninsured or Underinsured
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining Call or download
Receiving Mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 4 weeks
   

Medication

Amount/Supply Varies
Sent To Address of shipment varies by medication *See Additional Information section below
Delivery Time Within 2-4 weeks
Refill Process Patient or Doctor must contact company
Limit None
Re-application New application, new documentation yearly
   

Additional Information

This program also offers a Savings Card Program: Card activation is required.

*Lyrica, oral oncology, and specialty products are shipped to the patient's home, other medications to Doctor's office

For help with Prevnar 13, please contact customer service and talk to your health care provider. This program was formerly known as Pfizer Helpful Answers



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 October 24, 2014
 

Salix Pharmaceuticals Patient Assistance Program

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

Provided by: Salix Pharmaceuticals

PO Box 66520
St Louis MO 63166-6520

TEL: 866-282-6563


ALT PHONE:
FAX: 877-738-3694
Languages Spoken:

English, Others By Translation Service

Program Website

 

Patient Assistance Applications

Salix Pharmaceuticals Patient Assistance Program Application

Salix Patient Assistance Program Application for Fulyzaq

Salix Patient Assistance Program Application for Fulyzaq (Spanish)

Salix Patient Assistance Program Application for Xifaxan 550

Salix Diabetes Patient Information Form

Salix Ulcerative Colitis Patient Information Form

 

Medications

  • hydrocortisone Cream 1% (Proctocort)
  • hydrocortisone Cream 2.5% (Anusol-HC)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must have a verifiable US or US territory address (no PO Box)
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
Sent To Patient's home
Delivery Time Within 2 weeks
Refill Process Refill/reorder form included with shipment
Limit None
Re-application New application yearly
   

Additional Information

Must be at or below 500% FPL for Fulyzaq and Xifaxin.

Contact program for Spanish application.


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3. Updated December 11, 2014
 

Rx Outreach Medications

This program provides medication at low cost.

Provided by: Rx Outreach

PO Box 66536
St Louis, MO 63166-6536

TEL: 888-796-1234


ALT PHONE:
FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Rx Outreach Application

Rx Outreach Diabetic Supplies

Rx Outreach Refills and New Prescriptions Order Form

Rx Outreach Medication List

 

Medications

  • hydrocortisone Tablet 5mg, 10mg ()
 

Eligibility Requirements   

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
   

Application

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 and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day
   

Medication

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 Rx Outreach website for the exact price and most current medication list.
Contact Program for Spanish Application(s)/Form(s)