Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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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

  • medical device mouthpiece/mask (AeroChamber Plus Flow-Vu) Mouthpiece/Mask
 

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 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

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.

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.
 

myAbbVie Assist Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Allergan, 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: Contact program

 

Medications

  • medical device mouthpiece/mask (AeroChamber Plus Flow-Vu) Mouthpiece/Mask
 

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 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

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.

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.
 

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation


TEL: 800-675-8416


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program

HealthWell Foundation COVID-19 Ancillary Costs: Contact program

 

Medications

  • medical device mouthpiece/mask (AeroChamber Plus Flow-Vu) Mouthpiece/Mask
 

Eligibility Requirements   

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

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
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

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

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.

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 Program

For Healthcare Professionals Only

Provided by: Bioventus LLC


TEL: 833-692-8360


FAX: 833-692-8329
Languages Spoken:

English

Program Website

 

Program Applications and Forms

My BV360 Patient Assistance Program Application and Prescription

 

Medications

  • medical device injection (Durolane) Injection
 

Eligibility Requirements   

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

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

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

Resources for HEALTHCARE PROFESSIONALS ONLY.

Updated May 05, 2022