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

myAbbVie Assist Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: AbbVie Inc.

PO Box 270
Somerville, NJ 08876

TEL: 800-222-6885


FAX: 866-483-1305
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

myAbbVie Assist Patient Assistance Program Application

myAbbVie Assist Patient Assistance Program Application (Spanish)

 

Medications

  • atogepant tablet (Qulipta) Tablet
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Varies
Income At or below 600% of FPL
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must be a US resident and treated by a US licensed healthcare provider
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning 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 Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Varies
Delivery Time Varies
Refill Process Contact program for details.
Limit Varies
Re-application Varies
   

Additional Information

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.

Updated September 16, 2022