| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 4. 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 or mail from Doctor's office | ||
| 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 | Patient or Doctor must contact company | ||
| 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 May 09, 2022 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 4. 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: Allergan, 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: Contact program |
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Medications |
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|
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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 or mail from Doctor's office | ||
| 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 | Patient or Doctor must contact company | ||
| 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. |
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| Updated May 09, 2022 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 4. Scroll down to see them all. |
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HealthWell Foundation Copay ProgramThis is a copay assistance program |
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Provided by: HealthWell Foundation |
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TEL: 800-675-8416 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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HealthWell Foundation Copay Program Enrollment: Contact program |
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HealthWell Foundation COVID-19 Ancillary Costs: Contact program |
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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 | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Sent out or may be completed online | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Patient notified in writing | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Good for one year | ||
| Limit | Not specified | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change. |
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| Updated May 09, 2022 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 4 of 4. | |||
My BV360 Patient Assistance ProgramFor Healthcare Professionals Only |
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Provided by: Bioventus LLC |
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TEL: 833-692-8360FAX: 833-692-8329 |
Languages Spoken:
English |
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Program Applications and Forms |
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My BV360 Patient Assistance Program Application and Prescription |
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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? | Not specified | ||
| Income | At or below 300% of FPL | ||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
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| Obtaining | Doctor/Doctor's office must call, download or apply online | ||
| Receiving | Faxed or downloaded from website | ||
| Returning | Fax or submit online | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Inform Doctor that he/she is in need | ||
| Decision Communicated | Not specified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | Varies | ||
| Sent To | Doctor's office | ||
| Delivery Time | Varies | ||
| Refill Process | Contact program for details. | ||
| Limit | Contact the program for details | ||
| Re-application | Varies | ||
Additional Information |
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| Resources for HEALTHCARE PROFESSIONALS ONLY. |
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| Updated May 05, 2022 | |||
