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

Boehringer Ingelheim Cares Foundation Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Boehringer Ingelheim Pharmaceuticals, Inc.



Languages Spoken:

English, Others By Translation Service
 

Patient Assistance Applications
 

Generic Name Medications
 
 

Eligibility Requirements   
Insurance Status Must have no prescription coverage
Those with Part D Eligible? Yes, but contact program for details
Income Based on FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
   

Application
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and other requested documentation
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication
Amount/Supply Up to 90 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient or Doctor's office needs to contact company
Limit Not applicable
Re-application New application yearly
   

Additional Information
Eligibility determined on a case-by-case basis:
Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.

For Pradaxa and Tradjenta, patient must have an annual household income of up to 300% of the FPL.

For Gilotrif, patient must not use this programs application. Please contact the SolutionsPlus Access and Support Program 877-814-3915.


Updated January 04, 2017