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

Jardiance

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Boehringer Ingelheim Cares Foundation Patient Assistance Program

This program provides medication at no cost.

Provided by: Boehringer Ingelheim Cares Foundation, Inc.

PO Box 66745
St. Louis, MO 63166-6745

TEL: 800-556-8317


FAX: 866-851-2827
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Boehringer Ingelheim Cares Application

HIV Common Application: Boehringer Ingelheim Cares (APTIVUS, VIRAMUNE XR)

 

Medications

  • Jardiance (empagliflozin)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but contact program for details
Income Based on FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be a US resident
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach proof of income and other requested documentation
Decision Communicated Patient notified in writing
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient or Doctor's office needs to contact company
Limit Not specified
Re-application New application yearly
   

Additional Information

Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.

For Gilotrif, patient must not use this program's application. Please contact the BI Cares Foundation Gilotrif Patient Assistance Program at 877-814-3915.

For Ofev, patient must not use this program's application. Please contact the BI Cares Foundation Gilotrif Patient Assistance Program at 888-304-8946.


Updated January 28, 2019