Last Update - 10/31/2009
Free and Low Cost Medication Sources
The Patient Advocate Foundation (PAF) Co-Pay
Relief Program (CPR)
Contact Information 1-(866) 410-4225 (phone)
For participating pharmacies please visit http://www.freedrugcard.us
This is a free prescription drug discount card program that is open to everyone. You are not required to fill out an application. You can save an average of over 30% with savings as high as 75% on your prescriptions through this program. To obtain drug pricing, search participating pharmacies, and to download a membership card that can be used immediately go to their website. If you do not have access to the Internet call (Toll Free) 866-410-4225 and they will mail you a card. Participating pharmacies include the following: Walgreens, Kroger, Rite Aid, Publix, Osco, Walmart, Eckerd Drugs, SAV-ON, Longs Drug Store, Brooks Pharmacy, Winn Dixie, Albertsons, Super Fresh, and Target.
Contact Information: Express Scripts Specialty Distribution Services P.O. Box 66536 St. Louis, MO 63166-6536 1-(800) 769-3880 (phone)
Physician requests should be directed to: 1-(800) 769-3880 (phone)
Outreach is a patient assistance program that offers patients access to more than 125 safe
and affordable medications. Medications in this program cost $20, $30, or $40 for each
90-day supply, depending on the medication. Click here to visit the program's web site.
PS Card (Prescription Savings Card)
Information PS Card (Prescription Savings Card) 1-(888) 516-2535 (phone)
The PS Card allows card users to access discounted pricing for all prescription drugs at their local pharmacy. Discounts are up to 50% off the cash price for virtually all generic and brand-name prescription drugs at over 53,000 participating pharmacies nationwide. The PS Card is free and requires no membership. All individuals are eligible, regardless of employment, income, age, gender, or citizenship. A temporary PS Card may be printed from the website http://www.pscard.com. A permanent, personalized card may be requested on the website http://www.pscard.com or by phone (888-516-2535) at no cost to the user.
The mission of PS Card is to allow individuals with no
prescription drug insurance to enjoy pricing discounts usually available only to members
of benefit networks. The PS Card program is not insurance. Personal information is not
required from the user to obtain the discounted pricing for their prescription. All
prescription pricing is processed by a third-party pharmacy benefit services provider, so
all prescription information is kept fully confidential. Please see the program web site
at http://www.pscard.com to price prescriptions at local pharmacies and see other ways to save
money on prescriptions.
The Benefits Check Up Rx
Compare prices among several plans
Disability Resources. A nonprofit org. that provides information about
resources for independent living. Resources listed by by state.
Partnership for Prescription
Assistance. For a free directory, call 800-762-4636 or go to their website.
Patient Assistance Directory Pharmaceutical Research
& Manufacturers of America
Veteran and Military Benefits. If you are a veteran, call 877-222-8387 or go to this link to
see what you qualify for. If you are a military retiree or dependent, including current,
widowed or divorced spouse, call 800-538-9552 or go to this link.
HoosierRx P.O. Box
6224 Indianapolis, IN 46206-6224 1-(866) 267-4679 (phone)
Program. Contact Information: Healthwave PO Box 3599 Topeka, KS 66601 1-(800)
PO Box 1704 Louisville, KY 402011-(877) 524-4718 (phone)
Affairs Contact Information: Office of Elderly Affairs P.O. Box 80374 Baton Rouge, LA
70898 1-(225) 342-7100 (phone) 1-(225) 342-7133 (fax) Physicians should direct requests
to: Office of Elderly Affairs Office of the Governor P.O. Box 80374 1-(225) 342-7100
Service Center Contact Information: MassHealth Customer Service Center Central Processing
Unit PO Box 290794 Charlestown, MA 02129-0214 1-(800) 841-2900 (phone) Medical
Benefit Request (www.mass.gov/Eeohhs2/ docs/masshealth/appforms/ mbr.pdf)
MiRx Card Application Form (www.michigan.gov/ documents/MiRx_brochure_ 150dpi_103392_7.pdf) Contact Information 1-(866) 755-6479 (phone)
There is no age limit to participate in the MiRx Card program. When individuals fill out the application, they should include all eligible members of their family or household. Once your application is completed and processed, eligible applicants will receive their own MiRx card in the mail within two weeks along with a list of participating pharmacies in their area. To be eligible, applicants must: * Be a resident of the State of Michigan * Have no other prescription drug coverage * Have an income level at or below the state¹s median income level.
Beneficiaries of the MiRx Card program will save as much as 20 percent off the retail prices they would normally pay as a cash customer. The MiRx Card program is free. There is no cost for the card. There is no cost to enroll in the program. And, the MiRx Card is easy to use. MiRx Card holders will take their prescription and their MiRx card to their local participating pharmacy. The pharmacist will fill the prescription and charge the MiRx discounted price.
Contact Information: Big Sky Rx PO Box 202915 Helena, MT 59620-2915 1-(866) 369-1233 (phone) 1-(406) 444-1861 (fax) Big Sky Rx Brochure To Qualify for Big Sky Rx You Must: Be a Montana resident, Be on Medicare, and have an annual family income less than about $19,600 if you are single or about $26,400 if you are married and living together (this income changes on an annual basis). Click here to visit the program's web site.
person Under age 65 and disabled Annual income of less than $6,400 Limited assets.
Information: NJ Family Care PO Box 4818 Trenton, NJ 08650-8955 1-(800) 701-0710 (phone)
Information: Rebecca Soto 1-(800) 792-9745 (phone) In order to qualify for SLMB, single
applicants must have an income less than $11,172 and married applicants must have a
combined income less than $14,988. Assets may not exceed $4,000 for single persons or
$6,000 for married couples. To apply for SLMB applicants should contact the SLMB program
at the toll-free number.
Deductible Plan Application (www.health.state.ny.us/ nysdoh/epic/doh-3409.pdf)
Contact Information: EPIC P.O. Box 5018 Albany, NY 12212-5018 1-(800) 332-3742 (phone)
Family Health Plus is available to single adults, couples without children, and parents with limited income, who are between the ages of 19 and 64, are residents of New York State and United States citizens or fall under one of many immigration categories. If you have health insurance - either on your own or through your employer - you are not eligible to enroll. There are no limits on the amount of assets or resources (such as a bank account) that you can have and still be eligible to enroll in Family Health Plus. How much income you and your family can have and still be eligible for Family Health Plus depends upon how many people are in your family.
Before you sign an application, you must meet with an enrollment facilitator or with staff from your local social services district. Your application cannot be processed without a personal interview. The local social services district or other organizations listed on this page will meet with you and help you complete an application. Where do I go to apply?
Contact Information 1-(877) 543-7669 (phone) they are 18 years of age or younger, * they are not eligible for or fully covered by Medicaid, * they are not covered under other health insurance, * they are U.S. citizens or qualified aliens, * they are North Dakota residents, and * their families meet the income guidelines
Ohio Health Plans 30 E Broad Street 31st Floor Columbus, OH 43266-0423 1-(800) 324-8680 (phone) Available to children up to age 19 and pregnant women. Applicants must reapply for coverage every 12 months because income changes may affect eligibility status. Click here to visit the program's web site
Ohio's Best Rx PO Box 408 Twinsburg, OH 44087-0408 1-(866) 923-7879 (phone) Ohio residents who have no prescription drug insurance coverage and are age 60 or over; or under age 60 with no prescription drug insurance and income under 250% of the Federal Poverty Level (that would be $1995 per month for a single person or $2675 for a couple). Ohio's "Best Rx" is a prescription drug discount card program designed to lower the cost of prescriptions for Ohio residents without drug insurance coverage who are either aged 60 and over or any age with incomes less than 250% of the federal poverty level. The program started January 11, 2005. You can have both Ohio's Best Rx and other discount cards; however, only one card can be used for any one prescription. Click here to visit the program's web site.
Sooner Care Program 1000 NE 10th Street Oklahoma City, OK 73117 1-(800) 987-7767 (phone) Click here to visit the program's web site.
Medical Assistance Programs 500 Summer Street NE Salem, OR 97301-1077 1-(800) 359-9517
RIte Care contact information: RIte Care 600 New London Ave Cranston, RI 2920 1-(401) 462-5300 (phone)
The following groups may can qualify for RIte Care: families with children - with annual family income up to 185% of federal poverty level (FDP), children [up to age 19] - with annual family income of up to 250% FDP, pregnant women - with annual family income of up to 250% FDP. If an applicant applies for and is determined eligible for Medical Assistance and if his employer (or spouses employer) offers a DHS-approved health plan, then the applicant will be enrolled in RIte Share. If the employer does not offer an approved health plan or if the employee is not eligible to receive it then the applicant will be enrolled in RIte Care.
is Rhode Islands Medicaid managed care program that provides families on the Family
Independence Program and eligible uninsured pregnant women, parents, and children up to
age 19 with comprehensive health insurance coverage. Families receive most of their health
care through one of three participating health plans: Neighborhood Health Plan of Rhode
Island, United Healthcare of New England and Blue CHIP. To apply you may go to a local DHS
office to apply or apply by mail. Call our Info Line number below to request an
application For more information, or an application, please call the RIte Care/ RIte Share
Info Line:(401) 462-5300 English or Spanish. (401) 462-3363 TY Click here to
visit the program's web site.
The procedure for Humira is different from their other products. See below.
Contact Information: Amylin Patient Assistance Program
PO Box 8435 Gaithersburg, MD 20898 1-(800) 330-7647 (phone)
Amylin Patient Assistance Program provides temporary assistance to low income patients who
do not have, or do not qualify for, insurance or other prescription medication benefits.
You must meet certain criteria such as income, residency and diagnosis. Call the Amylin
Patient Assistance Program for more information and assistance in determining eligibility.
Astellas Pharma US Inc.
Drugs Covered: Protopic
Information: Patient Assistance Program for Protopic P.O. Box 221644 Chantilly,, VA
20153-1644 1-(800) 477-6472 (phone)
1-(800) 424-3727 Physician should direct requests to: Patient Assistance Program AstraZeneca Foundation P.O. Box 66551St. Louis, MO 63166-6551 1-(800) 424-3727 (phone) http:// www.astrazeneca-us.com/content/patientAssistance/astrazeneca-pap-landing.asp
is based on income level and absence of outpatient private prescription insurance,
third-party coverage, or participation in a public program. If requesting Arimidex,
Casodex, Nolvadex, Faslodex or Zoladex, dial the AstraZeneca Cancer Support Network at
866-992-9276 to obtain additional information about completing your application. If
approved, a three-month supply of the medication is sent directly to the patient's home or
other designated location with the exception of Seroquel, Faslodex, and Zoladex from the
mail-order fulfillment pharmacy. Refills can be written by the physician. With the
shipment, patient receives instructions on how to request next supply of medication.
Patient/family members/physician can obtain application forms from the AstraZeneca
Foundation by calling (800) 424-3727. Physicians also can obtain a packet of applications
from their AstraZeneca sales representative. Application forms available on website.
Axcan Scandipharm, Inc
Drugs covered: Urso 250, Viokase
Contact Information: Axcan Scandipharm Patient Assistance Program PO Box 52150 Pheonix, AZ 85072-2150 1-(866) 292-2679 (phone) Income guidelines apply and are calculated as a percentage of Federal Poverty Limit. Patients must be US residents and not have prescription coverage. You will be issued a pharmacy card to have the prescription filled. There is a $3.00 dispensing fee for each prescription.
Drugs covered: Avonex
Information: MS Active Source 14 Cambridge Center Cambridge, MA 02142 1-(800) 456-2255
(phone) 1-(617) 679-3100 (fax) Physician requests should be directed to: MS Active Source
1-(800) 456-2255 (phone)
Information PO Box 836 Somerville, NJ 08876 1-(866) 268-7325 (phone)
Information: Boehringer Ingelheim Cares Foundation c/o Express Scripts Specialty
Distribution Services, Inc. PO Box 66555 St. Louis, MO 63166-6555 1-(800) 556-8317 (phone)
1-(866) 851-2827 (fax)
Eligibility to be determined solely by BIPI. Patient must be a U.S. citizen or legal resident ineligible for prescription drug assistance through Medicare, Medicaid or any other public programs. Patient must meet established financial criteria. Current program specifics can be obtained by calling (800) 556-8317.
Information: Bristol-Myers Squibb Patient Assistance Foundation, Inc. 1-(800) 736-0003
(phone) 1-(800) 736-1611 (fax)
Information: Carnrick Laboratories 65 Horse Hill Rd Cedar Knolls, NJ 07927 1-(973)
267-2670 (phone) Determination is made on a case-by-case basis. Applicants must fall under
the federal poverty guidelines.
Drugs Covered: Fentora, Gabitril, Provigil, Vivitrol
Information: Forest Pharmaceuticals Patient Assistance Program 13600 Shoreline Dr St
Louis, MO 63045 1-(800) 851-0758 (phone) 1-(314) 493-7452 (fax)
Contact Information: Galderma Labs Patient Assistance Program 14501 N Freeway Ft Worth, TX 76177 1-(800) 582-8225 (phone) You doctor must submit a letter stating a need for refills. Click here to visit the program's web site.
Drugs covered: Advair Diskus, Advair HFA,
Agenerase, Albenza, Amerge, Amoxil, Arixtra, Augmentin ES, Augmentin XR, Augmentin,
Avandamet, AVANDARYL Tablets, Avandia, Avodart, Bactroban Cream, BACTROBAN Nasal,
Bactroban Ointment, Beconase AQ, Ceftin, Combivir, COREG CR, Coreg, Daraprim, Dexedrine,
Dyazide, Epivir, Epivir-HBV, Epzicom, Flonase, Flovent, FLOVENT HFA w/dosage counter,
Fortaz, Imitrex, Lamictal, Lanoxicaps, Lanoxin, Lexiva, Lotronex, Malarone, Mepron,
Parnate, Paxil CR, Paxil IR, RELENZA, Requip, Retrovir, Serevent Diskus, Timentin,
Trizivir, Valtrex, Ventolin, HFA, VERAMYST Nasal Spray, VESIcare, Wellbutrin SR,
Wellbutrin XL, Wellbutrin, Zantac Efferdose, Zantac, Ziagen, Zinacef, Zofran ODT, Zofran,
Information: King Pharmaceuticals 501 5th street Bristol, TN 37620 1-(877) 546-5332
(phone) 1-(423) 989-6279 (fax)
Extended-Release Tablets CII, Flexeril Tablets, Pancrease, Pancrease MT Capsules
Opthalmic Solution, Cozaar Tablets, EMEND, Fosamax Tablets, Hyzaar tablets, JANUMET
tablets, Januvia, Maxalt, Singulair, tablets and chewable tablets, Trusopt opthalmic
Drugs Covered: Comtan, Diovan HCT, Diovan, Elidel, Enablex, Exelon, Exforge, Famvir, Focalin, Focalin XR, Lamisil, Lescol, Lescol XL, Lotrel, Miacalcin Injection, Miacalcin Nasal Spray, Ritalin LA, Stalevo, Starlix, Tegretol, Tekturna, Trileptal, Voltaren Ophthalmic.
Contact Information: Novartis Pharmaceuticals Corporation Patient Assistance Program P.O. Box 66556 St. Louis, MO 63166-6556 1-(800) 277-2254 (phone) Physician requests should be directed to: Novartis Pharmaceuticals Corporation Patient Assistance Program P.O. Box 66556 St. Louis, MO 63166-6556 1-(800) 277-2254 (phone) The Novartis Pharmaceuticals Corporation Patient Assistance Program provides assistance to patients experiencing financial hardship who have no third-party insurance coverage for their medicines. Patient must be a U.S. Resident. Patient must not have prescription drug coverage (public or private). Patient must meet income eligibility criteria. Income eligibility varies by household size and product. Patient applications are evaluated on a case-by-case basis. Click here to visit the program's web site.
0.5mg/0.1mg, Activella 1.0mg/0.5mg, Vagifem 18, Vagifem 8
Patient cannot have or qualify for any government prescription coverage such as Medicare, Medicaid, Veteran's Administration or any state or local programs. Patient cannot have or qualify for any private prescription coverage such as an HMO or PPO. Patient's total household income must be at or below 200% of the Federal Poverty Level. Approved patients will receive a five month supply of medication sent to the physician's office. A new application must be submitted for a second request. A maximum of 2 requests will be granted to approved patients.
Information PO Box 66585 St. Louis, MO 63166-6585 Contact Information 1-866-706-2400
or go to PfizerHelpfulAnswers.cor
Drugs covered: Aciphex (rabeprazole sodium), Duragesic (fentanyl transdermal system) CII, Duragesic CII, Levaquin, Levaquin Tablets (levofloxacin), Nizoral, Nizoral (ketaconazole) Tablets, Parafon Forte, Parafon Forte DSC, Parafon Forte DSC (chlorzoxazone) Caplets, Sporanox, Sporanox (itraconazole) Capsules & Oral Solution, Sporanox Oral Solution, Ultracet, Ultracet (tramadol hydrochloride/acetaminophen tablets), Ultram, Ultram (tramadol HCL tablets), Ultram ER (tramadol HCL) Extended-Release Tablets
Contact Information Patient Assistance Program P.O. Box 221857 Charlotte, NC 28000-1857 1-(800) 652-6227 (phone) 1-(888) 526-5168 (fax) Physician requests should be directed to: Patient Assistance Program P.O. Box 221857 Charlotte, NC 28222-1857 1-(800) 652-6227 (phone)
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