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

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

FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website


Program Applications and Forms

Rx Outreach Application

Rx Outreach Application (Spanish)

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)



  • altretamine capsule () Capsule

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


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


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 February 09, 2024