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zubsolv

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Zubsolv Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Orexo US, Inc.

50 Whittemore Street
Gloucester, MA 01930

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 required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and/or Doctor are 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 Contact program for details.
Limit Contact the program for details
Re-application New enrollment every 6 months
   

Additional Information
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 May 22, 2023


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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

3171 Riverport Tech Center Dr.
Maryland Heights, MO 63043

TEL: 314-222-0472


ALT PHONE: 888-796-1234
FAX: 800-875-6591 		Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Application (Spanish)

Rx Outreach Refills Form

Rx Outreach Medication List (by Disease State)

Rx Outreach Medication List (by Disease State) (Spanish)

Rx Outreach Diabetic Supplies Order Form: Prodigy

Rx Outreach Diabetic Supplies Order Form: Prodigy (Spanish)
 

Medications
  • buprenorphine-naloxone (Zubsolv tablet; sublingual)
 

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes, but contact program for details
Income Determined case by case
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
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Patient and/or Doctor are 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 Varies
Re-application Not applicable
   

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 18, 2023


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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Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program
 

Medications
  • Zubsolv tablet; sublingual (buprenorphine-naloxone)
 

Eligibility Requirements   
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
Obtaining Call or complete online
Receiving Complete online or by phone
Returning Not applicable
Doctor's Action Varies
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 48 hours
   

Medication
Amount/Supply Not applicable
Sent To Patient is sent savings 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
*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.
Updated September 06, 2023