| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
View Coupon |
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Generic Assistance Program (GAP)This program provides medication at no cost. |
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Provided by: NeedyMeds and Rx Outreach |
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Languages Spoken:
English Spanish
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Patient Assistance Applications |
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Generic Name Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no prescription coverage for needed medication | |||||
| Those with Part D Eligible? | Yes, if medication is not covered or those in the donut hole | |||||
| Income | At or below 200% of FPL | |||||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |||||
| US Residency Required? | Must reside in the US and be under the direct care of a US physician | |||||
Application |
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| Obtaining | Call or download | |||||
| Receiving | Faxed, emailed, mailed or downloaded | |||||
| Returning | Email, fax or mail | |||||
| Doctor's Action | Complete section | |||||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | |||||
| Decision Communicated | ||||||
| Decision Timeframe | ||||||
Medication |
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| Limit | ||||||
| Re-application | New application yearly | |||||
Additional Information |
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| When approved, the medication vouchers will be mailed. |
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| Updated January 14, 2019 | ||||||
