Combivent Respimat Patient Assistance Programs

Combivent Respimat: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Combivent Respimat. 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.

Looking for a different medication?

Boehringer Ingelheim Cares Foundation Patient Assistance Program

(Program 1 of 2 — Scroll down to see them all )

Provided by: Boehringer Ingelheim Cares Foundation, Inc.
PO Box 66745 St. Louis, MO 63166-6745
TEL: 800-556-8317
FAX: 866-851-2827
Languages Spoken:
English Spanish Others By Translation Service
Program Website
Medications
  • Combivent Respimat (ipratropium bromide/albuterol)
Eligibility Requirements
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Yes, but contact program for details
  • Income Based on FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? Must be a US resident
Application
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach proof of income and other requested documentation
  • Decision Communicated Patient notified in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 90 day supply
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Patient or Doctor's office needs to contact company
  • Limit Not specified
  • Re-application New application yearly
Additional Information
Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible. For Gilotrif, patient must not use this program's application. Please contact the BI Cares Foundation Gilotrif Patient Assistance Program at 877-814-3915.
Updated October 5, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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Patient Access Network Foundation (PAN)

(Program 2 of 2 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Combivent Respimat (ipratropium bromide/albuterol)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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