Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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Core Connections Co-Pay Program

This is a copay assistance program.

Provided by: Medac Pharma Inc.

PO Box 5728
Louisville, KY 40255

TEL: 855-336-3322


Languages Spoken:

Program Website

 

Program Applications and Forms

 Core Connections Co-Pay Program: Contact program

 

Medications

  • methotrexate injection (Rasuvo) Injection
 

Eligibility Requirements   

Insurance Status Must be commercially insured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or enroll online
Receiving Not applicable
Returning Not applicable
Doctor's Action Not specified
Applicant's Action Complete online enrollment
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not applicable
Sent To Not applicable
Delivery Time Not applicable
Refill Process Not applicable
Limit Not applicable
Re-application Not specified
   

Additional Information

For eligible patients, the Co-pay Assistance Program will provide financial support up to $125 per month for up to 12 months.
Updated September 03, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 4.
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Core Connections Program

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

Provided by: Medac Pharma Inc.

4500 Progress Blvd.
Louisville, KY 40218

TEL: 855-336-3322


FAX: 800-481-3325
Languages Spoken:

Program Website

 

Program Applications and Forms

Medac Pharma Patient Assistance Program Application

CORE Connections Patient Support Brochure

 

Medications

  • methotrexate injection (Rasuvo) Injection
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Not specified
Income At or below 250% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Fax from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 1 month supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application New application yearly
   

Additional Information


Updated September 03, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 4.
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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


FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Diabetic Supplies

Rx Outreach Refills and New Prescriptions Order Form

Rx Outreach Medication List

 

Medications

  • methotrexate tablet () Tablet
 

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, mailed or downloaded from website
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)
Updated July 15, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 4.
 

Step Up, Start Up Copay Assistance Program

This is a copay assistance program.

Provided by: Antares Pharma


TEL: 855-202-5711


ALT PHONE: 855-687-3987
FAX: 646-419-4065
Languages Spoken:

English

Program Website

 

Program Applications and Forms

 Step Up, Start Up Copay Assistance Program Card: Contact Program

Step Up, Start Up Mail-In Rebate Form

 

Medications

  • methotrexate solution; subcutaneous (Otrexup) Solution; Subcutaneous
 

Eligibility Requirements   

Insurance Status Must be commercially insured
Those with Part D Eligible? No
Income Not Required
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident
   

Application

Obtaining No application
Receiving There is no application
Returning Not applicable
Doctor's Action Give prescription to patient
Applicant's Action Print copay card from program website, bring to pharmacy with prescription to receive savings
Decision Communicated Not applicable
Decision Timeframe Not applicable
   

Medication

Amount/Supply Not applicable
Sent To Not applicable
Delivery Time Not applicable
Refill Process Good for one year
Limit Maximum of 12 times in one year
Re-application Request a new card after one year
   

Additional Information

Eligible patients may save up to $125 on each prescription


Updated July 14, 2015