Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 
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Teva Cares Foundation Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Teva

PO Box 52028
Phoenix, AZ 85072

TEL: 877-237-4881


FAX: 877-438-4404
Languages Spoken:

English, Others By Translation Service

Program Website

 

Patient Assistance Applications

Teva Cares Foundation Patient Assistance Program Application

 

Brand Name Medications

 
  • AirDuo RespiClick powder; inhalation
  • ProAir Respiclick powder; inhalation
  • Gabitril tablet
  • Proglycem oral suspension
  • Galzin capsule
  • QNASL aerosol; nasal
  • Nuvigil tablet
  • QVAR RediHaler aerosol; inhalation
  • ProAir HFA aerosol; inhalation
 

Generic Name Medications

 
  • albuterol sulfate aerosol; inhalation
  • cyclosporine capsule
  • albuterol sulfate powder; inhalation
  • cyclosporine oral solution
  • armodafinil tablet
  • diazoxide oral suspension
  • beclomethasone dipropionate aerosol; inhalation
  • fluticasone propionate and salmeterol powder; inhalation
  • beclomethasone dipropionate aerosol; nasal
  • tiagabine tablet
  • clozapine tablet
  • zinc acetate capsule
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must permanently reside in the US and be under the direct care of a US Physician
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail (Note: faxed prescriptions are only valid if faxed directly from a prescriber'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 notified in writing
Decision Timeframe 5-7 business days
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Within 5-7 business days
Refill Process Reorder form needs to be submitted
Limit Varies per medication
Re-application New application yearly
   

Additional Information

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

Updated August 31, 2021