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Pharmaceutical Assistance Program

Some pharmaceutical companies offer assistance programs for the drugs they manufacture. Click on the first letter of your drug name to see if any programs are available for the drugs you are taking. If your drug is on the list, click on "details" for detailed information about the program.

Click the first letter of your drug name:

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Drug Details

Drug Name

Humira

Drug Company

Abbvie BioPharmaceutical Company

Drug Program

Abbvie Patient Assistance Foundation

Eligibility Criteria

  • Must reside in the U.S., Puerto Rico or the US Virgin Islands.
  • Patients without prescription drug coverage must meet specific financial criteria based on federal poverty guidelines.
  • Patients with prescription drug coverage, including being enrolled in a Medicare Prescription Drug Plan (Part D), who have difficulty accessing their Abbvie medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program (PAP)exception based on health-related expenditures and household income.
  • Patients enrolled in a Medicare Prescription Drug Plan (Part D) who are approved for Pharmaceutical Assistance Program (PAP)will be eligible for assistance through the end of the calendar year and are asked to reapply annually.

  • Patients experiencing financial difficulties.
  • Eligible patients typically have no healthcare coverage for the requested product and do not have access to alternative sources of coverage or funding.
  • All applications are reviewed on a case-by-case basis to support the Abbvie Patient Assistance Foundation’s purpose of providing products at no cost to individuals in need.


Benefits/Assistance

  • Medication provided at no cost to patient through the eligibility term.
  • Medication is shipped to either provider or patient for 90 days.

Re-application Policy:
  • New application every 12 months.

  • New financial information every 12 months.

  • Financial information required for Kaletra only.

Refill Policy:

  • It is the responsibility of the physician or office staff to contact Abbvie 3 weeks prior to the patient requiring further medication.

Website/Contact Information

Address:
P.O. Box 270
Somerville, NJ 08876

Phone: (800) 222-6885

Website: http://www.abbviepaf.org/index.cfm

Drug Name

Humira

Drug Company

Abbvie BioPharmaceutical Company

Drug Program

AbbVie Patient Assistance Foundation (HUMIRA)

Eligibility Criteria

  • The AbbVie Patient Assistance Foundation provides AbbVie medicines at no cost to patients experiencing financial difficulties.
  • Eligible patients typically have no healthcare coverage for the
    requested product and do not have access to alternative sources of coverage or funding.
  • All applications are reviewed on a case-by-case basis to support the AbbVie Patient Assistance Foundation's purpose of providing products at no cost to individuals in need.

Benefits/Assistance

  • Ensure all sections of the application are completed. Failure to complete required information will delay the review process.
  • Provide front and back copies of all prescription insurance card(s).
  • Provide proof of income for all in household.
  • o If there is no household income ($0) due to job loss or other circumstance, you do not need to provide income documents.

  • The application must be completed and signed by the patient and prescriber.
  • Note: If application is faxed, Prescriber MUST sign and fax it with MD office cover sheet.
  • Upon receipt of a completed application, the physician and patient will be notified of eligibility.
  • If
    approved, medication will be shipped to the destination indicated on the application.
  • It is the responsibility of the physician or patient to reorder 3 weeks prior to the patient requiring further medication.
  • Please note, if approved, medication will be scheduled for shipment to the specified location on the
    application.

Website/Contact Information

Address:
AbbVie Patient Assistance Foundation
San Bruno, CA 94066

Phone: (800) 222-6885

Website: http://www.abbvie.com/responsibility/patients-first/patient-assistance-programs.html

Drug Name

Humira

Drug Company

Healthwell Foundation

Drug Program

Healthwell Foundation Copay Program

Eligibility Criteria

  • You must have some form of health insurance (major medical or prescription drug) that covers part of the cost of your medication.
  • Healthwell cannot consider Health Savings Accounts (HSA), Health Retirement Accounts (HRA), or drug discount cards to be insurance.
  • Healthwell will refer patients without prescription insurance to other programs, such as drug company patient assistance programs and other copay foundations or support organizations.
  • Families with incomes up to 400 percent of the Federal Poverty Level may qualify.
  • HealthWell also considers the cost of living in a particular city or state.


  • Benefits/Assistance

    HealthWell is able to assist with medications for selected diseases only. We can assist with medications that have been prescribed to treat the disease/covered diagnosis. You will be asked to provide HealthWell with your diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. You must receive treatment in the United States.



    If we do not have an open fund that currently covers your diagnosis, please revisit the list as we frequently reopen programs or start new funds, as donations become available.



    Patients enrolled in the Healthwell Foundation are free to change their physicians, pharmacy, or other provider, or the type of medication they are taking for a specific disease at any time without affecting their eligibility for assistance.



    Healthwell grants assistance on a first-come, first-served basis to the extent that funding is available. The Healthwell Foundation Board of Directors sets the eligibility criteria and has final determination in all cases. Individuals covered by private insurance, Medicare or Medicaid may be eligible.



    Website/Contact Information

    Address:
    P.O. Box 4133









    Gaithersburg, MD 20885

    Phone: (800) 675-8416

    Website: http://www.healthwellfoundation.org/

    Drug Name

    Humira

    Drug Company

    Patient Access Network Foundation

    Drug Program

    PAN Foundation

    Eligibility Criteria

    • Patient is insured and insurance covers the medication for which the patient seeks assistance.

    • The medication must treat the disease directly.

    • Patient's income must be below a designated percentage of the Federal Poverty Level, depending on individual fund requirements.
    • Patient is prescribed a high cost drug for the disease, depending on individual fund requirements.
    • Patient must reside and receive treatment in the US.
    • You must have been diagnosed with a disease for which PAN has a program.

    Benefits/Assistance

    • Once PAN receives your fully completed application , we will have an answer for you by the business day. If you qualify for assistance, PAN will send you an approval letter including important details such as your award amount and your eligibility dates.
    • You will also receive a separate letter that will contain a plastic pharmacy card to be used for any qualifying prescription drugs. We will notify your doctor of your approval by fax.
    • If your application is not approved, we will make every effort to contact you by phone to explain the reasons for denial.
      Assistance starts on your approval date and continues for 12 month.
    • Your exact eligibility dates and grant amount will be included in your approval letter, and are also available at any time using our automated telephone system. During your first eligibility period eligible expenses incurred up to 90 days prior to your approval date may also be submitted for reimbursement.
    • All patients are required to complete a pre-screening. To begin the process patient are required to answer basic questions online. You will need your most recent income documentation, your insurance cards, and your doctor's information.
    • Once you have passed the pre-screening, you will be linked to the application form that you can download for your records.
    • PAN staff will coordinate your physician's form.

      OR



    • Call toll-free at 1-866-316-PANF (7263) to speak with a case manager (English or Spanish speaker) who can help you through the application process and answer any questions. The case manager will ask some simple questions to determine if you qualify.
    • If you qualify, you can authorize PAN case workers to virtually sign the application on your behalf. If you are not comfortable with virtual signature, we will mail a pre-filled application for you to sign. Complete that application and mail it or fax it to PAN.




    Website/Contact Information

    Address:
    PAN Foundation

    Charlotte, NC 28222

    Phone: (866) 316-7263

    Website: http://panfoundation.org/fundingapplication/index.php?5

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