Gilotrif Prescription Assistance Programs

Gilotrif: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Gilotrif. 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?

Patient Access Network Foundation (PAN)

(Program 1 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
  • Gilotrif tablet (afatinib tablet)
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 FDA Approved Diagnosis - See Program Website for Details
  • 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 November 22, 2019

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

Back to top

BI Cares Patient Assistance Program - Gilotrif

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

Provided by: Boehringer Ingelheim Cares Foundation, Inc.
BI Cares Patient Assistance Program - Gilotrif PO Box 5697 Louisville, KY 40255
TEL: 855-297-5904
FAX: 855-297-5905
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Gilotrif tablet (afatinib tablet)
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 30 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
None
Updated October 24, 2019

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

Back to top

Sign up for PharmacyChecker News

Exclusive drug savings tips & news straight to your inbox.

PharmacyChecker uses cookies to track & improve your online experience.