![]() It is the responsibility of the prescriber or office staff to reorder 3 weeks prior to the patient requiring further medication. For Norvir Assistance: Financial information section is not required.Ī supply of medication will be shipped to the prescriber’s office. The application must be completed and signed by the patient and prescriber. Upon receipt of a completed application, the physician and patient will be notified of PAP eligibility.ĭownload printable Form Humira Patient Assistance ApplicationĪbbVie Norvir Kaletra Patient Assistance Program It is the responsibility of the physician or patient to reorder 3 weeks prior to the patient requiring further medication. PAP medication will be shipped to the destination indicated on the application. Patient must provide front and back copies of all prescription insurance card(s). Eligible patients typically have no healthcare coverage for the requested product and do not have access to alternative sources of coverage or funding.Īll 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. The AbbVie Patient Assistance Foundation provides AbbVie medicines at no cost to patients experiencing financial difficulties. Ships to Doctor's office within 1-3 business days.ĭownload printable Form AbbVie Patient Assistance Foundation for Lupron DepotĪbbVie Patient Assistance Foundation (HUMIRA) New application must be completed yearly. Patient or Doctor must contact company for refills. Patient must complete application, sign and attach a copy of proof of income.Īmount/Supply varies. Doctor must complete and sign application. Patient and Doctor are notified within 2-3 business days.ĭiagnosis/Medical Criteria not specified. Must be a US Resident.Ĭall for application to be faxed, mailed, or download from website. Income requirements for this program have not been disclosed. Medicare PartD patients considered on exception basis. Must have no prescription coverage for needed medication. NOTE: Linked drugs are available for Prescribers to Apply Online now.Ĭlick drug logo or drug name to start online application.Īpplications that patients can fill out and bring to their doctor.ĭownload printable Form AbbVie Patient Assistance FoundationĪbbVie Patient Assistance Program for Lupron Depot Those with insurance may be eligible on an exception basis. Ships to Doctor's office within 7-10 business days. Patient must complete application, sign and provide annual income information. Patient and Doctor are notified of decision within 5-7 business days.ĭiagnosis/Medical Criteria not required. Must reside in the US.Ĭall to have application faxed, emailed, mailed or download from the website. May have private insurance must not be government funded. 5 Programs Sponsored By AbbVie (External Link)
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