| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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View Coupon |
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myAbbVie Assist for HumiraThis program provides brand name medications at no or low cost |
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Provided by: AbbVie |
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D-617927, AP5 NE TEL: 800-222-6885FAX: 866-250-2803 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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myAbbVie Assist for Humira Application |
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myAbbVie Assist for Humira Application (Large Font) |
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myAbbVie Assist for Humira Application (Spanish) |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must be uninsured or underinsured | ||
| Those with Part D Eligible? | Varies | ||
| Income | At or below 600% of FPL | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must reside in the US and be under the direct care of a US physician | ||
Application |
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| Obtaining | Call, download or apply online | ||
| Receiving | Complete online, download from website or faxed. | ||
| Returning | Fax or mail from Doctor's office | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | As prescribed by Doctor | ||
| Sent To | Patient's home, unless otherwise noted | ||
| Delivery Time | Varies | ||
| Refill Process | Company contacts patient or doctor to arrange | ||
| Limit | Varies | ||
| Re-application | Varies | ||
Additional Information |
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| Any patient who requires the medication and are in need should call the company. Eligibility determined on a case-by-case basis. Patients with prescription drug coverage may be eligible on exception basis. Contact program for details. |
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| Updated May 26, 2020 | |||
| 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. |
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View Coupon |
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Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Complete online or by phone | ||
| Doctor's Action | Will be discussed with patient and Doctor after request is received | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor notified in writing | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient sent card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated August 10, 2020 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
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View Coupon |
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Humira Pen and Syringe Disposal Service |
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Provided by: AbbVie Inc. |
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TEL: 800-448-6472 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Humira Pen and Syringe Diposal Service Enrollment: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Not specified | ||
| Those with Part D Eligible? | Not specified | ||
| Income | Not Required | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or enroll online | ||
| Receiving | Not applicable | ||
| Returning | Not applicable | ||
| Doctor's Action | Not applicable | ||
| Applicant's Action | Enroll online or by phone | ||
| Decision Communicated | Not specified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | 1 kit | ||
| Sent To | Patient's home | ||
| Delivery Time | Not specified | ||
| Refill Process | Patient must contact company | ||
| Limit | Not specified | ||
| Re-application | Not applicable | ||
Additional Information |
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| Patient enrolls to receive a free sharps container. |
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| Updated August 06, 2020 | |||
