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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
$23,540 or less

Family Size of 2
$31,860 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® 1
    (rilpivirine) Tablets
  • ELMIRON®
    (pentosan polysulfate
    sodium) Capsules
  • HALDOL®  
    (haloperidol) Immediate-Release Injection
  • HALDOL® Decanoate
    (haloperidol) IM Injection Only
  • INTELENCE® 1
    (etravirine) Tablets
  • INVEGA® 1
    (paliperidone)
    Extended-Release Tablets
  • INVEGA SUSTENNA®
    (paliperidone palmitate)
    Extended-Release Injectable
    Suspension
  • INVEGA TRINZA™
    (paliperidone palmitate) Extended-Release Injectable Suspension
  • INVOKAMET® 1
    (canagliflozin/metformin HCI) Tablets
  • INVOKANA® 1
    (canagliflozin) Tablets
  • LEVAQUIN® 1
    (levofloxacin) Tablets/Oral Solution
  • NUCYNTA®
    (tapentadol)
    Immediate-Release Tablets CII
  • NUCYNTA® ER
    (tapentadol)
    Extended-Release Tablets CII
  • PANCREAZE®
    (pancrelipase)
    Delayed-Release Capsules
  • PARAFON FORTE™ DSC
    (chlorzoxazone) Caplets
  • PREZCOBIX®
    (darunavir 800mg/cobicistat 150mg) Tablets
  • PREZISTA® 1
    (darunavir) Tablets/Oral Suspension
  • Razadyne®
    (galantamine HBr )
    Tablets/Oral Solution
  • Razadyne® ER
    (galantamine HBr)
    Extended-Release Capsules
  • RISPERDAL® 1
    (risperidone) M-TAB®
    Orally Disintegrating Tablets
  • RISPERDAL® 1
    (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® 1
    (topiramate capsules)
    Sprinkle Capsules
  • TOPAMAX® 1
    (topiramate) Tablets
  • ULTRACET®
    (tramadol HCL/acetaminophen)
    Tablets CIV
  • ULTRAM®
    (tramadol HCL) Tablets CIV
  • ULTRAM® ER
    (tramadol HCL)
    Extended-Release Tablets CIV
  • XARELTO® 1
    (rivaroxaban) Tablets

Single Person
$47,080 or less

Family Size of 2
$63,720 or less

Larger Families
Income levels are adjusted accordingly

  • DOXIL®  
    (doxorubicin HCL liposome)
    IV Infusion
  • MONOVISC®
    (high molecular weight hyaluronan) Injection
  • Natrecor®
    (nesiritide) IV Infusion
  • ORTHOVISC®
    (high molecular weight
    hyaluronan) Injection
  • PROCRIT® 1
    (epoetin alfa) Injection
  • REMICADE®
    (infliximab) IV Infusion
  • SIMPONI®
    (golimumab) Injection
  • SIMPONI ARIA®
    (golimumab) IV Infusion
  • STELARA®
    (ustekinumab) Injection
  • SYLVANT™
    (siltuximab) IV Infusion
  • ZYTIGA®
    (abiraterone acetate) Tablets

Single Person
$58,850 or less

Family Size of 2
$79,650 or less

Larger Families
Income levels are adjusted accordingly

  • Olysio®
    (simeprevir) Capsules

Single Person
$70,620 or less

Family Size of 2
$95,580 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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