State Programs Pharmacy and Organization Programs
Drug Company Programs Home Page

Last Update - 10/31/2009

 Free and Low Cost Medication Sources

Pharmacy and Organization Programs

The Patient Advocate Foundation (PAF) Co-Pay Relief Program (CPR)

Provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical co-payment assistance. The program offers personal service to all patients through the use of call counselors; personally guiding patients through the enrollment process.
http://www.copays.org/

FreeDrugCard.us

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.


HealthAllies Enhanced program

Recommended by the World Association of Persons with disAbilities [WAPD] http://www.wapd.org


HealthAllies, a division of United Healthcare, has developed the highest quality and most innovative
health savings program in the country. This is a Health Discount Program NOT a
health insurance plan
.

This savings program will also work with benefits not provided by existing insurance plans or Medicare. A wise consumer will consider utilizing this enhanced program provided through HealthAllies in order to maximize the use of your dollars to cover
out-of-pocket expenses. This program will provide nationwide discounts on out of pocket costs such as primary care doctors, hospital and outpatient surgery centers, physical therapy, prescription drugs, dental and eye-care services, hearing, wellness,
chiropractic, alternative medicine, laboratory tests, 24 hour nurse access by phone, and more.

The HealthAllies Enhanced program is affordable at only $19.95 per month*. This program covers the entire family. I suggest you look at their web site www.healthylife.optumhealthallies.com for more detailed information or
call 866-781-9030 to speak to one of their enrollment specialists or to request additional information.

Express-Scripts

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)

Rx 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)

Contact Information PS Card (Prescription Savings Card) 1-(888) 516-2535 (phone)
PS Card Web site

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

This service will provide you with a confidential, personalized report of public and private programs that can help you save money on some or all of your prescription drugs. Just give them  some basic information and they will check your potential eligibility for over 260 programs, including more than 1,450 prescription drugs. It is from the office of aging, but do not let that deter you, the programs are for anybody who needs help. Go HERE to fill in the form to find help with your prescription prices.


AARP's Discount Mail Order Program. Call 800-289-8849 or go to this link.


Accessing Free Medication - The Patient's Advocate

Destination 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.

Needy Meds.

Patient Assistance Directory Pharmaceutical Research & Manufacturers of America
Call for booklet:  1-
888-477-2669 . At least 42 companies will provide free medicine to uninsured patients in need. Your Doctor must attest  it would be a hardship for you to buy them.

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.
*New information. After publishing a newsletter featuring organizations available to help you with the rising cost of medication and health care, we received a large amount of feedback. One of the items discussed was the V.A. Center in Spokane, WA. It seems they do not  believe in, or treat FM. If you are currently following a routine prescribed by a private doctor this facility may force you to abandon your routine for a cheaper therapy. They do not believe in pain meds and will only prescribe medications approved by their insurance plan.


Write for a booklet that explains the procedure involved in applying for free medications.
PHRMA Pharmaceutical Research and Manufacturers of America 1100 Fifteenth Street, N.W. Washington, D.C. 20005



State Programs


California

Discount Drug Program
Contact: 1-(800) 434-0222 (phone)  Click here to visit the program's web site.


Delaware


Lewis Building, DHSS Campus, Herman Holloway Sr. Campus 1901 N. DuPont Highway New Castle, DE 19720 1-(800) 996-9969 (phone) You must reside in the state of Delaware and be at  least 65 years old or qualify for Social Security Disability benefits. Your  income must be at or below 200% of the Federal Poverty Level. Individuals with income over 200% of FPL can qualify if they have prescription costs exceeding 40% of their income.


Illinois

Access to Care. Contact Information: Access to Care 2225 Enterprise Drive Suite 2504 Westchester, IL 60154 1-(708) 531-0680 (phone) 1-(708) 531-0686 (fax)

Your family must be at or below 200% of the federal poverty level, you may not have  health insurance (or a deductible of $500 or more per person), you must be ineligible for Medicaid or Medicare and residence in suburban Cook County There are Non-Refundable Annual Enrollment Fees:  $20 for one person,  $40 for two people, $50 for three or more people in one family. Fees are based on family size of eligible applicants. A family is defined as husband, wife, and number of children under age 21. To register for an appointment, call 708-531-0680. Registration is also available by mail. Click here to visit the program's web site.


Indiana

HoosierRx P.O. Box 6224 Indianapolis, IN 46206-6224 1-(866) 267-4679 (phone)
This is a program for seniors. You must meet the following guidelines: You must be 65 years old or older, you must reside in Indiana permanently, you cannot have prescription drug coverage through an insurance plan, Medicaid or Medicaid with a spend-down. You may have a Medicare-Approved Drug Discount Card. Your monthly income must not exceed $1,097 or less, if single.  $1,464 or less, if married. All interested seniors are asked to fill out a short, one-page application and send it to HoosierRx with proof of their monthly income. An application typically takes 4 weeks to process, but could take up to 6 weeks. Once the application is processed, the senior will receive an eligibility letter. If eligible, the senior will receive a HoosierRx Drug Card and instructions on how to use their card at the pharmacy to get 75% off the price of their prescriptions. If the senior is denied eligibility, they will receive a denial letter.

How do I use my HoosierRx Drug Card? Take your HoosierRx Drug Card to your pharmacy and present it to the pharmacist. The pharmacist will enter the information into the pharmacy computer system and you will get 75% off the cost of your prescriptions. Remember, you will only receive 75% off the cost of your prescriptions until you have used all of your maximum benefit. However, after your maximum benefit is met, you can still continue to use your HoosierRx Drug Card to get a small discount on prescriptions. Click here to visit the program's web site.


Kansas

Health Insurance Continuation Program
Contact Information 1-(816) 513-6230 (phone) The Health Insurance Continuation (HIC) program will pay for part or all of ADAP eligible clients' insurance premiums and co-pays. The Insurer must agree to the program. Allow 25 working days for processing. Contact a Local CARE Consortium to enroll (see link below for a list of consortiums).  Click here to visit the program's web site.

Healthwave Program. Contact Information: Healthwave PO Box 3599 Topeka, KS 66601 1-(800) 792-4884 (phone)
Applicant must be a resident of Kansas. Click here to visit the program's web site.


Kentucky

KCHIP   PO Box 1704 Louisville, KY 402011-(877) 524-4718 (phone)
Click here to visit the program's web site.


Louisiana

Elderly 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 (phone)
Who's covered.

Seniors age 60 and older who are legal Louisiana residents.
Seniors with an income below 300% of the poverty level.
Seniors with a chronic illness taking prescribed daily medications for the condition.
Seniors who do not have insurance covering medications.  Seniors who have not voluntarily cancelled state/federal prescription drug programs or a private reimbursement plan within 6 months.
SeniorRx does not provide assistance for obtaining short-term medicines to meet acute needs, including antibiotics.
Click here to visit the program's web site.


Maryland

Pharmacy Assistance Program PO Box 386 Baltimore, MD 21203-0386 1-(800) 226-2142 (phone) Pharmacy Assistance Program Application (www.dhmh.state.md.us/ mma/mpap/pdf/MPPApplication.pdf) The Maryland Pharmacy Program (MPP) helps eligible Maryland residents pay for medically necessary prescriptions. The Program has two benefit groups: 1) Maryland Pharmacy Assistance Program 2) Maryland Pharmacy Discount Program.
The Maryland Pharmacy Assistance Program is for people with incomes (such as earnings and social security), at or below $869 monthly for one person ($1,010 monthly for a couple) and with assets (such as bank accounts and homes, etc.) below $4,000 for one person ($6,000 for a couple). The Maryland Pharmacy Discount Program is for people who receive Medicare and have monthly incomes below $1,310 for one person ($1,768 for a couple). Money in bank accounts and the value of other assets are not counted for the Pharmacy Discount Program. The Pharmacy Assistance Program recipient pays a $5 co-payment for each original prescription and refill. Effective October 1, 2003, the Pharmacy Assistance co-payment will be $2.50 for all generic products and some brand name drugs. Certain brand name drugs will be $7.50. The State pays a reduced cost and not the regular retail price for most prescriptions. The Discount Program recipient pays 65% of the State’s reduced cost, plus a $1 processing fee. There is no monthly premium to enroll in either Program.


Click here to visit the program's web site.


Massachusetts

Customer 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)
The Division of Medical Assistance manages MassHealth. MassHealth pays for health care for certain low- and medium-income people living in Massachusetts who are under age 65 and who are not living in nursing homes or other long-term-care facilities.


These include:
- families with children under age 19
- children under age 19
- pregnant women
- people out of work for a long time
- disabled people
- adults who work for a qualified employer
- people who are HIV positive

The Division offers health-care benefits directly or by paying part or all of your health-insurance premiums. Certain persons aged 65 or older may also be eligible for MassHealth if they are parents or caretaker relatives of children under age 19, or are disabled and working 40 or more hours a month. The Division will decide if you are eligible and give you the most complete coverage that you qualify for.
Click here to visit the program's web site.\


Michigan

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.


Missouri


Senior RX Contact Information: 205 Jefferson Street, Room 1310 Jefferson City, MO 651011-(800) 375-1406 (phone)

In order to apply outside of the open-enrollment period, you must have experienced a "qualifying event". A qualifying event occurs when an applicant has their 65th birthday after the January 1, 2005 through February 28, 2005 enrollment period. Applicants who turn 65 after the enrollment period may apply within 30 days prior to their birthday or within 30 days after their birthday. Applicants must submit a paper application and other required documents. Applications submitted, approved, and fee paid after the July 1, 2005 plan year start date will only be eligible for benefits from that enrollment date through June 30, 2006. Benefits cannot be retroactive back to July 1, 2005.  Click here to visit the program's web site.


Montana

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.


Nevada


Senior Rx Contact Information: Senior Rx 1761 E. College Parkway Bldg B, Ste 113 Carson City,, NV 89706 1-(800) 303-6323 (phone)
Nevada Senior Rx Application (nevadaseniorrx.nv.gov/ SeniorRxApplication.pdf)
AGE: Applicant and spouse (if spouse is also applying) must be 62 years of age at the date of application. INCOME: Effective July 1, 2005: Total combined applicant and spouse income can be no more than $30,168 per year. Total income for a single person can be no more than $23,175 per year.

Applicants must have lived continuously in Nevada for at least one year (12 consecutive months) PRIOR to the date of application.  You cannot receive full Medicaid benefits (prescription benefits) and Senior Rx at the same time. If you are eligible for SSI (Supplemental Security Income) in Nevada, you are also eligible for full Medicaid benefits, including prescription coverage, at no cost to you.

Please contact the Social Security Administration at 1-800-772-1213 if you believe your situation matches one of the following:

Single person Under age 65 and disabled Annual income of less than $6,400 Limited assets.
Single person Age 65 or order Annual income less than $6,900 Limited assets
Single person Annual income of less than $7,700 Limited assets
Married couple Age 65 or older Annual income of less than $10,500 Limited assets


Click here to visit the program's web site


New Jersey

Contact Information: NJ Family Care PO Box 4818 Trenton, NJ 08650-8955 1-(800) 701-0710 (phone)
Must be 18 year old or younger and living in New Jersey. For families larger than six people, please call to determine your monthly income guidelines. Please visit the following link for information on Medical Assistance Customer Centers-MACCs For Beneficiary and Provider Services: http://www.state.nj.us./humanservices/dmahs/mddi2.html
Click here to visit the program's web site.

New Jersey

Contact 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.

SLMB (along with SLMB QI-1) pay Medicare Part B premiums for eligible New Jersey residents who are not financially eligible for the Qualified Medicare Beneficiary (QMB) program under New Jersey Medicaid (also know as New Jersey Care...Special Medicaid Programs).
Click here to visit the program's web site.


New York

EPIC 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)
New York State residents can join EPIC if they are 65 or older, and have an annual income of $35,000 or less if single, or $50,000 or less if married. Seniors who receive full Medicaid benefits or have other prescription coverage that is better than EPIC are not eligible for EPIC benefits. EPIC is a cost sharing program. Seniors with moderate incomes pay a low quarterly fee, and participate in the Fee Plan. Seniors with higher incomes meet an annual deductible, and participate in the Deductible Plan. Those who pay a fee or meet their deductible make a copayment at the pharmacy when purchasing prescriptions. Click here to visit the program's web site.


Family Health Plus. Contact Information: 1-(877) 934-7587 (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.

Single Adult $9,570
Couples with No Children $12,830
Family Size 2 $19,245
Family Size 3 $24,135
Family Size 4 $29,025
Family Size 5 $33,915
Family Size 6 $38,805
Family Size 7 $43,695

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?


North Dakota

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

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.


Oklahoma

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.


Oregon

Office of Medical Assistance Programs 500 Summer Street NE Salem, OR 97301-1077 1-(800) 359-9517 (phone)
Click here to visit the program's web site.


Rhode Island

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 spouse’s 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.

RIte Care is Rhode Island’s 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.
 



Drug Company Programs


Abbott

Drugs Covered. AdvicorTablets, Azmacort Inhalation Aerosol, Biaxin Filmtab, Biaxin Granules, Biaxin XL Filmtab, Cardizem LA Tablets, Depakote ER Tablets, Depakote Sprinkle Capsules, Depakote Tablets, Gengraf Capsules, K-Tab Tablets, Mavik Tablets, NiaspanTablets, Omnicef Capsules, Synthroid Tablets, Tarka Tablets, Teveten, Teveten HCT, TriCor Tablets

Contact Information: Abbott Patient Assistance Program D-31C, AP52 200 Abbott Park Road Abbott Park, IL 60064-6214 1-(800) 222-6885 (phone) 1-(866) 898-1473 (fax)

Physician requests should be directed to: Abbott Patient Assistance Program 200 Abbott Park Road, D-31C, AP52 Abbott Park, IL 60064-6214 1-(800) 222-6885 (phone) Abbott Homepage (www.abbott.com)

NOTE: The procedure for Humira is different from their other products. See below.

HUMIRA Contact Information: HUMIRA Resource Center P.O. Box 789 San Bruno, CA 94066 1-(800) 448-6472 (phone) 1-(866) 323-0661 (fax) Physician requests should be directed to: Abbott HUMIRA Resource Center 1-(800) 448-6472 (phone)

Humira Homepage (www.humira.com)
Eligibility: The program provides HUMIRA at no cost to eligible, low income individuals who do not have or qualify for prescription medication benefits through private insurance or government-funded programs, e.g. Medicaid or Medicare.


You or your doctor can obtain an application by contacting the HUMIRA Resource Center at 1-800-4HUMIRA (1-800-448-6472). The HUMIRA Resource Center assists physicians and their patients by providing reimbursement services, consideration for HUMIRA assistance programs, and enrollment into consumer support services.


Amylin

Drugs Covered: Byetta, Symlin.

Contact Information: Amylin Patient Assistance Program PO Box 8435 Gaithersburg, MD 20898 1-(800) 330-7647 (phone)
Physician requests should be directed to: Amylin Patient Assistance Program PO Box 8435 Gaithersburg, MD 20898 1-(800) 330-7647 (phone)

The 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

Contact Information: Patient Assistance Program for Protopic P.O. Box 221644 Chantilly,, VA 20153-1644 1-(800) 477-6472 (phone)
Physician requests should be directed to: Patient Assistance Program for Protopic P.O. Box 221644 Chantilly, VA 20153-1644 1-(800) 477-6472 (phone) To be eligible for the program, patients must meet residency, diagnosis, income, and insurance criteria.  Call the company and if you qualify the staff will send a pre-filled application to the patient or physician. Note: If approved, you will receive two shipments.  If continued therapy is needed beyond one year you must reapply to the program.

AstraZeneca

Drugs Covered: Accolate Tablets, Arimidex, Atacand, Atacand HCT, Casodex, Crestor, Faslodex, Nexium, Nolvadex, Plendil Tablets, Pulmicort Respules, Rhinocort Aqua Nasal Spray, Seroquel, Toprol XL, Zoladex, Zomig ZMT Oral Disintegrating Tablets, Zomig Nasal Spray,Zomig Tablets

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

Eligibility 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.

Reapplication is required every 12 months. A reapplication is automatically sent to enrolled patients.
Enrollment in the program requires a valid Social Security or Green Card number. Patient is required to submit financial documentation.

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.

Biogen Idec

Drugs covered: Avonex

Contact 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)

Eligibility is based on patient's insurance status and income level.


Biovail Pharmaceuticals, Inc.


Drugs covered:
Teveten, Zovirax

Contact Information PO Box 836 Somerville, NJ 08876 1-(866) 268-7325 (phone)

Patient must have already been enrolled and receiving Cardizem from the patient assistance program that was previously available through Aventis; no new applications will be accepted for any form of Cardizem. New patients can apply for Teveten and Zovirax. The patient must be a legal resident of the US. The patient cannot have any third party coverage for prescriptions from public or private sources. Patient's household income must be less 200% of the federal poverty level. If you have questions, call between 9-5 pm EST. Call for form; they will automatically fax it. Completed application must be mailed back.


Boehringer Ingelheim Pharmaceuticals, Inc.


Drugs covered: Aggrenox Capsules, Aptivus Capsules, Atrovent Inhalation Aerosol, Catapres-TTS Transdermal Patch ,Combivent Inhalation Aerosol, Flomax Capsules, Micardis HCT Tablets, Micardis Tablets, Mirapex Tablets, Spiriva HandiHaler,Viramune Oral Suspension, Viramune Tablet.

Contact 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)
Physician requests: Boehringer Ingelheim Cares Foundation, Inc. c/o Express Scripts Specialty Distribution Services, Inc. P.O. Box 66555 St. Louis, MO 63166-6555 1-(800) 556-8317 (phone)

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.


Bristol-Myers Squibb Company


Drugs covered: Avalide, Avapro, Coumadin, EMSAM, Kenalog vial, Lodosyn tablet, Plavix tablet

Contact Information: Bristol-Myers Squibb Patient Assistance Foundation, Inc. 1-(800) 736-0003 (phone) 1-(800) 736-1611 (fax)
Physician requests should be directed to: Bristol-Myers Squibb Patient Assistance Foundation, Inc. 1-(800) 736-0003 (phone)
Bristol-Myers Squibb Patient Assistance Foundation Application


This program provides temporary assistance to patients with a financial hardship who are not eligible for prescription drug coverage through Medicaid or any other public or private health program.

Carnrick Laboratories

Contact 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.

Centocor, Inc.

Drug Covered: Remicade

Contact Information: Patient Assistance Program for Remicade P.O. Box 221709 Charlotte, NC 28222 1-(866) 489-5957 (phone) 1-(866) 489-5958 (fax)
Physician should contact: Patient Assistance Program for Remicade P.O. Box 221709 Charlotte, NC 28222-1709 1-(866) 489-5957 (phone) Remicade Patient Assistance Application

The Remicade Patient Assistance Program is a service to provide the product to low-income patients legally residing in the United States when patients meet certain financial need qualifications. When patients qualify, they may be provided with up to six months of the product at a time.


Cephalon

Drugs Covered: Fentora, Gabitril, Provigil, Vivitrol


Fentora patient Assistance Program P.O. Box 4280 Gaithersburg, MD 20885-4280 1-(877) 433-6867 (phone) 1-(866) 495-0657 (fax)  If you do not have prescription drug coverage you could be eligible for the Fentora Patient Assistance Program.

Contact: Gabitril Patient Assistance Program P. O. Box 4280 Gaithersburg, MD 20885-4280 1-(866) 209-7589 (phone) 1-(866) 209-7596 (fax) Patients who do not have prescription drug coverage could be eligible for the GABITRIL Patient Assistance Program. The patient must not be eligible for public and private insurance reimbursement (including Medicare Part D), and must meet certain income restrictions and U.S. residency requirements.

Contact Information: PROVIGIL Patient Assistance Program P.O. Box 1968 Danbury, CT 06813-1968 1-(800) 675-8415 (phone) 1-(240) 632-3811 (fax) Patients who do not have prescription drug coverage could be eligible for the PROVIGIL Patient Assistance Program. The patient must not be eligible for public and private insurance reimbursement (including Medicare Part D), and must meet certain income restrictions and U.S. residency requirements.

Contact Information: Vivitrol. VIP3 Program P.O. Box 549 San Bruno, CA 94066-0549 1-(800) 848-4876 (phone) 1-(877) 329-8484 (fax)
Resources: Vivitrol Patient Assistance Program Application


Cetylite Industries, Inc

Drug Covered: Cetacaine

Contact Information: PO Box 90006 Pennsauken, NJ 08110 1-(800) 257-7740 (phone) 1-(609) 665-5408 (fax)

Eligibility is determined on a case by case basis. There is no formal program but they will help you if they can. Put in a request via fax.


Daiichi Sankyo, Inc
.

Drugs Covered: Benicar Tablets, Welchol Tablets. Contact Information: Sankyo Pharma Open Care Program PO Box 8409 Somerville, NJ 08876 1-(866) 268-7327 (phone) Physicians should contact: Sankyo Pharma Open Care Program P.O. Box 8409 Somerville, NJ 08876 1-(866) 268-7327 (phone)

The program is available to qualified patients with demonstrated medical and financial need. The program assists patients who are prescribed Sankyo products and are uncertain of their insurance coverage, and in locating alternative payment sources. Free product is provided to uninsured patients who qualify and for whom no alternative source of reimbursement can be identified. Patients must reside in the United States and have a U.S. treating physician. :
The physician's office must apply on behalf of a patient. Applications are available from Sankyo Pharma representatives or from Sankyo Pharma Open Care Program hotline-(866) 268-7327. Upon receipt and approval of a completed application, all patients will receive a supply (the amount depends on the product) of medication, which will be shipped to the physician's office on the patient's behalf. Patients who remain on therapy will complete reimbursement counseling to identify alternative sources of insurance. Patients without alternative sources of insurance will continue to receive free product. Periodic reviews of applications will be conducted to ensure continued eligibility.


ECR Pharmaceuticals

Drugs Covered: Anaplex DM, Anaplex HD, Lodrane Allergy, Lodrane LD, Pneumotussin

Contact Information: Patient Assistance Program P.O. Box 71600 Richmond, VA 23255 1-(800) 527-1955 (phone) 1-(804) 527-1959 (fax) Physician determines patients need. Physician must mail a letter stating patients need and an original script. A stock bottle will be sent to the Prescribers office.


Eisai Inc.


Drug Covered: Zonegran

Contact Information: Patients in Need P.O. Box 679 Somerville, NJ 08876 1-(866) 694-2550 (phone) 1-(866) 803-5631 (fax)


Eli Lilly and Company

Drugs covered: Cymbalta, Evista, Humalog, Humulin, Prozac Weekly, Prozac, Reopro, Strattera, Symbyax, Zyprexa.

Contact: Lilly Cares PO Box 230999 Centerville, VA 20120 1-(800) 545-6962 (phone) Physician should direct requests to: Lilly Cares P.O. Box 230999 Centreville, VA 20120 1-(800) 545-6962 (phone)  Lilly Cares Application

Patients must be legal U.S. residents. Eligibility is determined on a case-by-case basis. Eligibility is based on the patient's income level, and lack of third- party drug coverage (including Medicare Prescription Drug Benefit, Medicaid, private Rx insurance, government-subsidized clinics, and other government, community, or private programs). Inpatients and those who can obtain drug reimbursement from any source are not eligible. Requests for replacement drugs cannot be honored. Medications are provided directly to the physician for dispensing to the patient. Quantity of supply is dependent upon type of product being prescribed, but usually in 4 month supply. All Lilly medications must be used as recommended in product labeling. Enrollment period is for 1 year, and refills are requested by Fax Refill Form (included in the shipment) by the prescriber. Final eligibility can only be determined by completing an application.

EMD Serono Inc.

Drug covered: Saizen

Contact Information: 1-(800) 582-7989 (phone) 1-(877) 408-4288 (fax) Physician requests should be directed to: EMD Serono (Saizen Patient Assistance Program) 1-(800) 582-7989 (phone)


Forest Parmaceuticals


Drugs covered: AeroBid,Aerochamber/Mask, Armour Thyroid, Celexa, Kay Ciel, Levothroid, Lexapro, Tessalon, Theochron, Thyrolar, Tiazac.

Contact Information: Forest Pharmaceuticals Patient Assistance Program 13600 Shoreline Dr St Louis, MO 63045 1-(800) 851-0758 (phone) 1-(314) 493-7452 (fax)

Income guidelines apply. The patient must not be able to afford the medication and qualify under guidelines that the company does not release. It is important that the address on the prescription matches the mailing address on the application. A new application is required every three months.  Call to get an application, it will be faxed or mailed. The application is also available on the web: www.forestpharm.com/pap. The blank application can also be copied. The completed application must be mailed back to the company. Program's web site.


Galderma Laboratories, Inc

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.


GlaxoSmithKline

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, Zovirax, Zyban.

Contact Information 1-(866) 728-4368 (phone) Program is Advocate-based. All contact for the Patient is through an Advocate. Please visit website (www.BridgesToAccess.com) for more information. GSK Access, a new Patient Assistance Program, began in January 2007 for low income and disabled Medicare Part D participants. Please visit the website (www.GSK-Access.com) for more details. Click here to visit the program's web site.


Ivax Indigent Patient Assistance Program


Drugs covered: Clozapine

4400 Biscayne Blvd Miami, FL 33137 1-(800) 507-8334 (phone) Eligibility is based on financial need and lack of prescription coverage.


King Pharmaceuticals, Inc.

Contact Information: King Pharmaceuticals 501 5th street Bristol, TN 37620 1-(877) 546-5332 (phone) 1-(423) 989-6279 (fax)

Patient must be a legal resident of the United States. Patient cannot have  any government prescription drug coverage such as Medicaid, Veteran’s Administration, or any state or local programs. Patient cannot have Medicare Part D prescription drug coverage. (If the patient is eligible for Medicare Part D, the patient should be encouraged to enroll.) Patient cannot have any private prescription drug coverage. Call Monday-Friday, 9:00AM - 5:00PM Eastern Time
Click here to visit the program's web site.


McNeil Pediatrics, A Division of McNeil-PPC, Inc.

Drugs covered: Concerta Extended-Release Tablets CII, Flexeril Tablets, Pancrease, Pancrease MT Capsules

Contact Information Patient Assistance Program P.O. Box 221857 Charlotte, NC 28222-1857 1-(800) 652-6227 (phone) 1-(888) 526-5168 (fax) Physician should contact: Patient Assistance Program P.O. Box 221857 Charlotte, NC 28222-1857 1-(800) 652-6227 (phone)   Program will ensure that McNeil Consumer and Specialty Pharmaceuticals prescription products Concerta® (methylphenidate HCL) Extended-Release Tablets CII; Flexeril® (cyclobenzaprine HCL) Tablets; Pancrease® MT (pancrelipase) Capsules will be provided free of charge to those U.S. residents who lack access to prescription drug coverage and meet specific financial criteria. Medicare LIS (Low Income Subsidy) eligible patients are not eligible to receive assistance through the Patient Assistance Program. Patients receiving benefits under a Medicare Part D prescription drug plan are not eligible to receive assistance through the Patient Assistance Program, however program eligibility exceptions for Medicare Part D enrollees based on significant financial or medical need will be considered. If necessary, patients may reapply after initial supply.


Merck Prescription Discount Card

Drugs covered: Cosopt Opthalmic Solution, Cozaar Tablets, EMEND, Fosamax Tablets, Hyzaar tablets, JANUMET tablets, Januvia, Maxalt, Singulair, tablets and chewable tablets, Trusopt opthalmic Solution

Contact Information: Merck Prescription Discount Card PO Box 369 Horsham, PA 19044-9945 1-(800) 506-3725 (phone) 1-1-800-50-MERCK (toll free phone) Physician requests should be directed to: Merck Prescription Discount Card PO Box 369 Horsham, PA 19044-9945 1-(800) 506-3725 (phone)  You must reside in the United States and have a valid prescription that originates in the U.S. from a licensed U.S. doctor. You may not seek reimbursement for any portion of the prescription cost from any third party, including federal and state programs. You may enroll from every state  and participate in the program. Click here to visit the program's web site.


Novartis

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.


Novo Nordisk

Drugs Covered: Activella 0.5mg/0.1mg, Activella 1.0mg/0.5mg, Vagifem 18, Vagifem 8

Contact Information Novo Nordisk Patient Assistance Program PO Box 1096 Somerville, NJ 08876 1-(866) 668-6336 (phone)

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.


Orphan Medical, Inc.

Drugs covered: Cystadane

Contact Information c/o NORD PO Box 1968 Danbury, CT 06813 1-( 800) 999-6673 (phone)   Each case is reviewed individually, but is based on patient's income and lack of prescription coverage. The patient is given assistance up from 25%-100% for one year. Anyone can call to start the process, and after some phone screening an application is sent to the patient, case worker or physician. The completed application must be mailed back to the company.


Pfizer

Contact Information PO Box 66585 St. Louis, MO 63166-6585 Contact Information 1-866-706-2400 or go to PfizerHelpfulAnswers.cor

Drugs Covered: Accupril, Accuretic, Antivert, Arthrotec, Caduet, Cardura, Celebrex, Chantix, Cortef, Covera-HS, Cytotec, Detrol, Detrol LA, Diabinese, Diflucan, Dilantin, Dostinex, Feldene, Geodon, Glucotrol XL, Glucotrol, Glyset, Inspra, Lipitor, Minipress, Minizide, Navane, Neurontin, Nicotrol Inhaler, Nicotrol NS, Norvasc, Procardia XL, Procardia, Relpax, Rescriptor, Sinequan, Tikosyn, Viagra, Vibramycin, Viracept, Vistaril, Xalatan, Zarontin, Zithromax, Zoloft, Zyrtec.
Genotropin, Somavert

Physician should direct requests to: Pfizer Inc Connection to Care™ Patient Assistance Program P.O. Box 66585 St. Louis, MO 63166-6585 1-(800) 707-8990 (phone)

Applicant's total family household income must be at or below 200% of the Federal Poverty Level. Applicant must not have any insurance or receive any benefits that help pay for prescription medicines such as Medicaid, Medicare prescription drug coverage (Medicare Part D), State-sponsored prescription drug assistance programs or other employee, military, retirement or pension program drug coverage. Hardship Exceptions: Lower income patients who have insurance coverage for prescription medicines may still be eligible for assistance through the Pfizer Connection to Care patient assistance program if they are experiencing significant financial or medical hardship. Please contact Connection to Care at 800-707-8990 for more information.

To enroll in the program, patients must submit a completed application, a copy of their most recent tax return with supporting financial information and an original prescription from their doctor. A patient may qualify for this program if a patient is underinsured or does not have any insurance coverage. In addition, a patient must meet medical necessity criteria, along with financial guidelines. The physician or a patient can call The Bridge Program at (800) 645-1280 to initiate the reimbursement counseling and/or patient assistance process.


PriCara, Unit of Ortho-McNeil, Inc.

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)


Purdue Pharma

Drugs covered: Oxycontin, OxyIR

Contact Information: Purdue Pharma Patient Assistance Program P.O. Box 66547 St. Louis, MO 63166-6547 1-(800) 599-6070 (phone) Physician requests should be directed to: 1-(800) 599-6070 (phone)

Patients must not have insurance coverage and must not qualify for Medicaid or any other medication assistance program. Patient must include information about income and insurance. The Physician's office must call on behalf of patient. Physician completes, signs and attaches prescription. The product is provided in 30-day supply. Product is shipped to the patient by Federal Express. Medication is only provided if patient is approved for the program. Medication is not shipped to the patient before the application is reviewed. If the patient is approved for the program, the physician must write an original script each month for the patient. There is a $25 co-pay per prescription.

Return to Top



Please help us keep our programs and services going!  Please give what you can.  Thank you!


Designed, developed and owned by
The Fibromyalgia Community,
a CSSA Partner, (a 501(c)3
non-profit corporation)
maintained by
Chip Davis and Jane Kohler

Copyright © 1996-2009
The Fibromyalgia Community
All Rights Reserved

Health Information Disclaimer
Privacy Policy


http://www.fmscommunity.org/awmmenupath.gif