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If you are eligible, the programs below can help you afford . Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.
If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.
(Program 1 of 2. Scroll down to see them all.)
Provided by: Rx Outreach |
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PO Box 66536
St. Louis, MO 63166-6536
TEL: 888-796-1234 FAX: 800-875-6591 |
Languages Spoken: English, Spanish Program Website |
Medications |
Eligibility Requirements |
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Insurance Status |
May have insurance
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Those with Part D Eligible? | Yes | |
Income | At or below 300% of FPL | |
Diagnosis/Medical Criteria | Not required | |
US Residency Required? | The patient must also be residing in the US. |
Application |
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Obtaining | Call, download or apply online | |
Receiving | Faxed, mailed or downloaded from website | |
Returning | Fax or E-Prescribe online | |
Doctor's Action | Give prescription to patient | |
Applicant's Action | Complete section and sign | |
Decision Communicated | Medications sent if accepted. If denied patient and doctor notified | |
Decision Timeframe | Usually same day |
Medication |
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Amount/Supply | Varies | |
Sent To | Doctor's office or patient's home | |
Delivery Time | Not specified | |
Refill Process | Company contacts patient to arrange | |
Limit | Only limited by manufacturer's guidelines | |
Re-application | New application yearly |
Additional Information |
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Some medications are available for a fee of $20 for up to a 180 day supply.
Check the Rx Outreach website for the exact price and most current medication list.
Contact Program for Spanish Application(s)/Form(s).
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Updated 6/27/2017 |
(Program 2 of 2. Scroll down to see them all.)
Provided by: HealthWell Foundation |
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PO Box 220410
Chantilly, VA 20153-0410
TEL: 800-675-8416 FAX: 800-282-7692 |
Languages Spoken: English, Others By Translation Service Program Website |
Medications |
Eligibility Requirements |
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Insurance Status |
May have insurance
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Those with Part D Eligible? | Yes | |
Income | Varies | |
Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |
US Residency Required? | The patient must also be residing in the US. |
Application |
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Obtaining | Call or complete online | |
Receiving | Sent out or may be completed online | |
Returning | The completed application must be mailed back. | |
Doctor's Action | Complete section and sign | |
Applicant's Action | Complete section, sign, attach a copy of proof of income | |
Decision Communicated | Patient notified in writing | |
Decision Timeframe | 3-5 business days |
Medication |
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Amount/Supply | Not applicable | |
Sent To | Varies | |
Delivery Time | Not specified | |
Refill Process | Good for one year | |
Limit | Not specified | |
Re-application | New application every 12 months |
Additional Information |
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This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.
Call for most recent medications as the list is subject to change.
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Updated 5/22/2017 |