Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
Scroll down to see them all.
 

Arbor Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Arbor Pharmaceuticals, LLC.

PO Box 6123
Lawrenceville, NJ 08648

TEL: 844-884-8700


FAX: 844-287-5417
Languages Spoken:

English Others By Translation Service

Program Website

 

Program Applications and Forms

Arbor Patient Assistance Program Application

 

Medications

  • azilsartan medoxomil tablet (Edarbi) Tablet
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Varies. **See below for details
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be US citizen or permanent resident
   

Application

Obtaining Call or download
Receiving Mailed
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 2 business days, once application process is complete
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 48 hours
Refill Process Patient must contact company
Limit Maximum of 3 refills through 12/31 of current calendar year
Re-application New application yearly
   

Additional Information

Must be at or below 300% FPL for BiDil.
Must be at or below 200% FPL for all other medications.

Call for most recent medications as the list is subject to change.

This program also provides copay assistance.


Updated September 17, 2018


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

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

  • azilsartan medoxomil (Edarbi) 
 

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 Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent 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 July 10, 2018