Auvi-Q Patient Assistance Programs

Auvi-Q: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Auvi-Q. 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?

Kaleo Cares Patient Assistance Program (Auvi-Q)

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

Provided by: Kaleo, Inc.
None
TEL: 877-302-8847
FAX: 800-943-1730
Languages Spoken:
English, Spanish
Program Website
Medications
  • Auvi-Q (epinephrine)
Eligibility Requirements
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? No
  • Income Gross annual household income at or below $100,000
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified by phone
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Patient's home
  • Delivery Time Within 48 hours
  • Refill Proces Contact program for details.
  • Limit Contact the program for details
  • Re-application New application every 12 months
Additional Information
None
Updated October 29, 2018

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Rx Outreach Medications

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

Provided by: Rx Outreach
PO Box 66536 St. Louis, MO 63166-6536
TEL: 888-796-1234
FAX: 800-875-6591
Languages Spoken:
English, Spanish
Program Website
Medications
  • None (epinephrine)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Not required
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • 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
  • Amount/Supply Varies
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Company contacts patient to arrange
  • Limit Only limited by manufacturer's guidelines
  • Re-application New application yearly
Additional Information
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).
Updated September 10, 2018

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