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AbbVie Patient Assistance Foundation
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AbbVie Patient Assistance Foundation
PO Box 270
Somerville, NJ 08876
Phone
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(800)222-6885
Fax:
(866)898-1473
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Eligibility
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May have private insurance; must not be government funded. Must've been denied LIS. Mustn't be eligible for Medicaid. Income requirements are based on FPL. Must reside in the US. |
| Who Can Apply
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Call to have application faxed, emailed, mailed or download from the website. Return application via fax or mail. Patient and Doctor are notified of decision within 5-7 business days. |
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Required
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Diagnosis/Medical Criteria not required. Doctor must complete and sign application. Patient must complete application, sign and provide annual income information. Proof of income required. |
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Supply
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Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Ships to Doctor's office within 7-10 business days. |
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Note
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Those with insurance may be eligible on an exception basis. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
| | Gengraf capsule | | Synthroid |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form AbbVie Patient Assistance Foundation | (Requires Acrobat Reader) 
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AbbVie Patient Assistance Program for Lupron Depot
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PO Box 270
Somerville, NJ 08876
Phone
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(800)222-6885
Fax:
(866)483-1305
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Eligibility
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Must have no prescription coverage for needed medication. Medicare PartD patients considered on exception basis. Income requirements for this program have not been disclosed. Must be a US Resident. |
| Who Can Apply
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Call for application to be faxed, mailed, or download from website. Return application via fax or mail. Patient and Doctor are notified within 2-3 business days. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor must complete and sign application. Patient must complete application, sign and attach a copy of proof of income. |
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Supply
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Amount/Supply varies. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Ships to Doctor's office within 1-3 business days. |
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Note
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Negative decision may be appealed. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
| | Lupaneta Pack injection and tablet | | Lupron Depot injection | | Lupron Depot-PED injection |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form AbbVie Patient Assistance Foundation for Lupron Depot | | (Requires Acrobat Reader)
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AbbVie Patient Assistance Foundation (HUMIRA)
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D-617927, AP5 NE
1 N. Waukegan Rd.
North Chicago, IL 60064
Phone
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800-222-6885
Fax:
866-250-2803
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Eligibility
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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. |
| Who Can Apply
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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. |
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Required
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The application must be completed and signed by the patient and prescriber. Proof of income must be attached. Patient must provide front and back copies of all prescription insurance card(s). |
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Supply
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PAP 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. |
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Ship To
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Either Doctor's office or Patient's home |
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Note
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Upon receipt of a completed application, the physician and patient will be notified of PAP eligibility. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
| | HUMIRA Pre Filled Syringe | | HUMIRA Self Injectable Pen |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form Humira Patient Assistance Application | | (Requires Acrobat Reader)
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AbbVie Norvir Kaletra Patient Assistance Program
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PO Box 270
Somerville, NJ 08876
Phone
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800-222-6885
Ext OPT 2
Fax:
866-483-1305
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Eligibility
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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. |
| Who Can Apply
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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. |
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Required
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The application must be completed and signed by the patient and prescriber. For Norvir Assistance: Financial information section is not required. |
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Supply
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A supply of medication will be shipped to the prescriber’s office. It is the responsibility of the prescriber or office staff to reorder 3 weeks prior to the patient requiring further medication. |
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Ship To
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Prescriber's office |
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Note
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Upon receipt of a completed application, the prescriber and patient will be notified of program eligibility. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
| | Kaletra Oral Solution | | Kaletra Tablets | | Norvir Oral Solution | | Norvir Soft Gelatin |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form AbbVie Norvir Kaletra Patient Assistance Program | | (Requires Acrobat Reader)
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AbbVie Patient Assistance Foundation (AndroGel & Creon)
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PO Box 270
Somerville, NJ 08876
Phone
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(800)222-6885
Fax:
(800)276-9901
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Eligibility
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This program is intended for patients that have no prescription coverage. Medicare PartD patients may be considered on exception basis. Income requirements for this program have not been disclosed. Must be US resident. |
| Who Can Apply
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Call to have application faxed, mailed or download from website. Return application via fax or mail from Doctor's office. Patient notified in writing of decision within 7-10 business days. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor must complete application, sign and attach prescription. Patient must complete application, sign and attach copy of proof of income. |
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Supply
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Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application, new documentation must be completed yearly. |
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Ship To
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Ship to Doctor's office or patient's home. |
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Note
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Exceptions to guidelines considered. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
| | AndroGel gel 1.62% | | Androgel Pump | | Creon capsule; delayed release |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form AbbVie Patient Assistance Foundation for Androgel and Creon | | (Requires Acrobat Reader)
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