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Zubsolv Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Orexo US, Inc.

PO Box 219
Gloucester, MA 01931

TEL: 888-236-4167


FAX: 888-246-6527
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Zubsolv Patient Assistance Program Application

 

Medications

  • Zubsolv tablet; sublingual (buprenorphine/naloxone)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes, if medication is not covered
Income At or below 300% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Yes, with prescription from US doctor
   

Application

Obtaining Call or download
Receiving Faxed, emailed, mailed or downloaded
Returning Email, fax or mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and valid photo ID
Decision Communicated If denied, patient and doctor notified
Decision Timeframe 2-3 weeks
   

Medication

Amount/Supply 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Once approved; within 2-5 business days
Refill Process Patient must contact company
Limit Up to one year
Re-application New enrollment every 6 months
   

Additional Information

This program also provides copay assistance: 1-888-982-7658

*The manufacturer supporting this program does not charge for applying to the program nor for any products applicants receive. Applicants using the services of a commercial advocacy service may have to supply additional documentation. 


Updated November 14, 2019


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Rx Outreach Medications

This program provides medication at low cost. (Most brand names are provided for reference purposes only)

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 Refills and New Prescription Form

Rx Outreach Medication List

Rx Outreach Diabetic Supplies Order Form (Prodigy)

 

Medications

  • buprenorphine/naloxone (Zubsolv tablet; sublingual)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 400% 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 September 17, 2019