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

Program 1 of 6   Scroll down to see them all.  Updated April 16, 2013 Back | Print Page

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

Pfizer Connection to Care

Provided by:


Pfizer, Inc.
PO Box 66585
St. Louis, MO 63166-6585

TEL: 866-706-2400


ALT PHONE:
FAX: 866-470-1748
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

hydrocortisone   (Cortef)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 200% of FPL, adjusted for household size
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
Obtaining Call or download
Receiving Mailed
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe 2-4 weeks
Amount/Supply Not specified
Sent To Lyrica to patient's home, other medications to Doctor's office
Delivery Time Within 4 weeks
Refill Process Doctor needs to go online or call in reorder/refill 855-742-7497
Limit None
Re-application New application, new documentation yearly

Additional Information:

This program has absorbed the medications on the former Wyeth and King PAP programs. Those with insurance may qualify on hardship basis. For Lyrica only: the prescription and a copy of the patient's driver's license or other picture ID must be sent with the application and other requirements may apply.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 6   Scroll down to see them all.  Updated June 19, 2013 Back | Print Page

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

Arbor Patient Assistance Program

Provided by:


Arbor Pharmaceuticals
951 Clint Moore Road
Suite A
Boca Raton, FL 33487

TEL: 888-417-7153


ALT PHONE:
FAX: 407-641-9566
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

hydrocortisone Lotion 2% (Pediaderm HC)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but have been denied or are ineligible for Low Income Subsidy
Income Based on FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income and include Medicaid denial letter
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 weeks
Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Patient needs to contact company
Limit None
Re-application New application yearly

Additional Information:

Must be at or below 300% FPL for BiDil.
Must be at or below 200% FPL for all other medications.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 6   Scroll down to see them all.  Updated June 11, 2013 Back | Print Page

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

Salix Pharmaceuticals Patient Assistance Program

Provided by:


Salix Pharmaceuticals
PO Box 66520
St Louis MO 63166-6520

TEL: 866-282-6563


ALT PHONE:
FAX: 877-738-3694
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

  • hydrocortisone  Cream 1% (Proctocort)
  • hydrocortisone  Cream 2.5% (Anusol-HC)
  • hydrocortisone  Suppository 25mg (Anusol-HC)

Eligibility Requirements

APPLICATION

MEDICATION
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
US Residency Required? Must be citizen or legal resident
Obtaining Call or download
Receiving Sent to doctor or patient
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Within 2 weeks
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 400% FPL for Xifaxin.

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

Program 4 of 6   Scroll down to see them all.  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

hydrocortisone Suppository 25mg (Anucort-HC)

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

Program 5 of 6   Scroll down to see them all.  Updated January 14, 2013 Back | Print Page

This is a discount card program.

Together Rx Access

Provided by:


Together Rx Access, LLC
One Outlet Lane
Bald Eagle Court
Lock Haven, PA 17745

TEL: 800-444-4106


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

hydrocortisone Tablet 5mg, 10mg, 20mg (Cortef)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No, must be ineligible
Income At or below $45,000 if single, $60,000 for family of 2, $75000 for 3, $90,000 for4, $105,000 for 5
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Enroll online
Receiving Downloaded from website
Returning Mail
Doctor's Action Not applicable
Applicant's Action If eligible, respond to 4 questions to enroll
Decision Communicated Patient notified
Decision Timeframe Not applicable
Amount/Supply Not applicable
Sent To Patient sent savings card to be used at pharmacy
Delivery Time Not applicable
Refill Process Not applicable
Limit Not applicable
Re-application Not applicable

Additional Information:

The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications.

Call for most recent medications as the list is subject to change.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 6 of 6.  Updated April 30, 2013 Back | Print Page

This is a discount card program.

Pfizer Pfriends

Provided by:


Pfizer, Inc.
PO Box 66543
St Louis, MO 63133

TEL: 866-706-2400


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

hydrocortisone   (Cortef)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
Obtaining Call or download
Receiving Faxed or mailed
Returning Mail
Doctor's Action Give prescription to patient
Applicant's Action Complete
Decision Communicated Patient notified in writing
Decision Timeframe 2-4 weeks
Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Card shipped within 3 weeks
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application Patient contacts company

Additional Information:

The Pfizer Pfriends savings program is not health insurance.



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.