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

Akrimax Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Akrimax Pharmaceuticals

PO Box 31035
Charlotte, NC 28231

TEL: 855-856-6915


FAX: 919-443-1483 		Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Akrimax Patient Assistance Program Enrollment Form
 

Brand Name Medications Covered
 
  • Primlev tablet
  • Tirosint
 

Generic Name
 
  • levothyroxine
  • oxycodone and acetaminophen tablet
 

Eligibility Requirements   
Insurance Status Must be uninsured
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Yes
   

Application
Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription and include a cover page with contact info, medical provider address, DEA number and patient name
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication
Amount/Supply Up to 30 day supply
Sent To Doctor's office or patient's home
Delivery Time Within 2 weeks
Refill Process PAP support line
Limit Varies per medication
Re-application New application yearly
   

Additional Information


Updated April 09, 2018