| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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myAbbVie Assist Patient Assistance ProgramThis program provides brand name medications at no or low cost |
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Provided by: AbbVie Inc. |
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PO Box 270 TEL: 800-222-6885FAX: 866-483-1305 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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myAbbVie Assist Patient Assistance Program Application |
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myAbbVie Assist Patient Assistance Program Application (Spanish) |
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Medications |
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Eligibility Requirements |
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| 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 |
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| Obtaining | Call or download | ||
| Receiving | Faxed or downloaded from website | ||
| Returning | Fax, mail or submit online | ||
| 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 |
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| 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 |
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| 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. |
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| Updated August 14, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 3. Scroll down to see them all. |
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Viatris Patient Assistance Program (Group One Medicines)This program provides brand name medications at no or low cost |
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Provided by: Viatris Inc. |
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TEL: 888-417-5780FAX: 877-427-7290 |
Languages Spoken:
English |
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Program Applications and Forms |
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Viatris Patient Assistance Program (Group One Medicines) Application
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Viatris Patient Assistance Program (Group One Medicines) Application: Clozapine
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Medications |
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Eligibility Requirements |
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| Insurance Status | Uninsured or Underinsured with no prescription coverage for needed medication | ||
| Those with Part D Eligible? | Not specified | ||
| Income | Determined case by case | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must be residing in the US or a US territory, and under the care of a US physician | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed or downloaded from website | ||
| Returning | Email or fax | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Not specified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | As prescribed by Doctor | ||
| Sent To | Doctor's office | ||
| Delivery Time | Varies | ||
| Refill Process | Contact program for details. | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
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| Eligibility determined on a case-by-case basis. Contact program for details. |
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| Updated December 06, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Rx Outreach MedicationsThis program provides medication at low cost. (Most brand names are provided for reference purposes only) |
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Provided by: Rx Outreach |
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3171 Riverport Tech Center Dr. TEL: 314-222-0472FAX: 800-875-6591 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Rx Outreach Application |
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Rx Outreach Application (Spanish) |
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Rx Outreach Medication List (by Disease State) |
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Rx Outreach Medication List (by Disease State) (Spanish) |
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Rx Outreach Diabetic Supplies Order Form: Prodigy |
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Rx Outreach Diabetic Supplies Order Form: Prodigy (Spanish) |
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| 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). |
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| Updated December 04, 2023 | |||
