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

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


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


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 December 15, 2021