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Eligibility

Eligibility

Most patients without insurance and with limited incomes qualify for our patient assistance programs. Many factors are considered when a patient applies to one of our programs. Examples include family size, the product you are taking, and other special circumstances. If you are struggling to pay for your medicines, we encourage you to apply.

You may be eligible if you ...

You do not have public or private prescription drug coverage
You reside in the United States (or United States Territory)
You are being treated by a U.S.- licensed healthcare provider
You are being treated as an outpatient
You meet the income eligibility for the products below

Single Person
$23,340 or less

Family Size of 2
$31,460 or less

Larger Families
Income levels are adjusted accordingly

  • AXERT®
    (almotriptan malate tablets)
  • CONCERTA®
    (methylphenidate HCI)
    Extended-release Tablets CII
  • DITROPAN XL®
    (oxybutynin chloride)
    Extended Release Tablets
  • DURAGESIC®
    (FENTANYL TRANSDERMAL SYSTEM) CII
  • EDURANT®
    (rilpivirne) Tablets
  • ELMIRON® -100 mg
    (pentosan polysulfate sodium)
    Capsules
  • HALDOL® Decanoate
    (haloperidol)  For IM Injection Only
  • HALDOL® 
    brand of haloperidol Injection
    (For Immediate Release)
  • INTELENCE®
    (etravirine) Tablets
  • INVEGA®
    (paliperidone)
    Extended-Release Tablets
  • INVEGA® SUSTENNA®
    (paliperidone palmitate)
    Extended-Release Injectable Suspension
  • INVOKANA™
    (canagliflozin) Tablets
  • LEVAQUIN®
    (levofloxacin) Tablets/Oral Solution
  • NUCYNTA®
    (tapentadol)
    immediate-release oral tablets C-II
  • NUCYNTA® ER
    (tapentadol)
    extended-release oral tablets
  • PANCREAZE®
    (pancrelipase) Delayed-Release Capsules
  • PARAFON FORTE® DSC
    (chlorzoxazone) Caplets
  • PREZISTA®
    (darunavir) Tablets/Oral Suspension
  • Razadyne®
    galantamine HBr Tablets and Oral Solution
  • Razadyne® ER
    galantamine HBr
    EXTENDED-RELEASE CAPSULES
  • RISPERDAL®
    (risperidone) M-TAB®
    orally disintegrating tablets
  • RISPERDAL®
    (risperidone) tablets/ oral solution
  • Risperdal® Consta®
    (RISPERIDONE)
    LONG-ACTING INJECTION
  • SPORANOX®
    (ITRACONAZOLE) CAPSULES
  • SPORANOX®
    (itraconazole) Oral Solution
  • Terazol® 3
    (terconazole) VAGINAL CREAM
  • Terazol® 7
    (terconazole) VAGINAL CREAM
  • TOPAMAX®
    (topiramate capsules) Sprinkle Capsules
  • TOPAMAX®
    (topiramate) Tablets
  • ULTRACET®
    (tramadol hydrochloride/
    acetaminophen tablets)
  • ULTRAM®
    (tramadol hydrochloride tablets)
  • ULTRAM® ER
    (tramadol HCL)
    Extended-Release Tablets
  • XARELTO®
    (rivaroxaban)

Single Person
$46,680 or less

Family Size of 2
$62,920 or less

Larger Families
Income levels are adjusted accordingly

  • DOXIL®  
    (doxorubicin HCL liposome injection)
    for intravenous infusion
  • Natrecor®
    (nesiritide) for Injection
  • ORTHOVISC®
    High Molecular Weight Hyaluronan
  • PROCRIT®
    (Epoetin alfa) FOR INJECTION
  • REMICADE®
    (infliximab) for IV Injection
  • SIMPONI®
    (golimumab) Injection, Solution for subcutaneous use
  • SIMPONI® ARIA™
    (golimumab) for infusion
  • STELARA®
    (ustekinumab) Injection
    For subcutaneous use
  • SYLVANT™
    (siltuximab) for Infusion
  • ZYTIGA®
    (abiraterone acetate) Tablets

Single Person
$58,350 or less

Family Size of 2
$78,650 or less

Larger Families
Income levels are adjusted accordingly

  • OLYSIO™
    (simeprevir) Capsules

Single Person
$70,020 or less

Family Size of 2
$94,380 or less

Larger Families
Income levels are adjusted accordingly

  • IMBRUVICA™
    (ibrutinib) Capsules

About Medicare, Medicaid and other government programs

In most instances, Medicare and Medicaid provide comprehensive drug coverage for their enrolled patients. For this reason, patients who are enrolled in Medicare and/or Medicaid are generally not eligible for our patient assistance programs. In some cases, patients do not have specific product coverage under these programs and may be eligible to receive assistance.

Patients actively enrolled in Medicare Part D are only eligible to participate in our program through an exception process if they demonstrate a significant financial hardship and/or medical need.

For more information on Medicare and Medicaid programs, please visit the Centers for Medicare & Medicaid Services website at http://www.cms.hhs.gov.


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