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Patient Assistance Information

 
3 Programs for Parnate Tablets
 
 
GlaxoSmithKline Bridges to Access Program

PO Box 29038,Phoenix, AZ 85038-9038
Phoenix, AZ 85038-9038
Phone : 866-728-4368
Fax:
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level. The patient must also be a US resident.
Who Can Apply
> The patient advocate can call for an application or start the application process on line.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies.
Supply
>
Ship To
> Patient's home advocate
Note
> The patient advocate can call for an application or start the application process on line.
 
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.
 
Parnate Tablets
 
 
 
Orange Card

Orange Card
,
Phone : (888) 672-6436
Fax:
Eligibility
> Seniors age 65 and older and the disabled enrolled in Medicare with annual income below $30,000 single/$40,000 couple (approximately 300% of poverty) and patient must not have public or private insurance coverage for prescription medicines.
Who Can Apply
> Patient should call for application.
Required
> Minimal information is required.
Supply
>
Ship To
>
Note
> Discounts are 25% off the wholesale list price of GlaxoSmithKline outpatient drugs. Participating pharmacies charge card holders no more than a negotiated price. GlaxoSmithKline expects card holders to realize average savings of 30-40% off retail prices.
 
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.
 
Parnate Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Rx Outreach Medications

PO Box 66536
St Louis, MO 63166
Phone : (888)796-1234
Fax: (800)875-6591
Eligibility
> Patients with insurance, including Medicare Part D, are eligible. Patients must be at or below 300% of the federal poverty level and reside in the US.
Who Can Apply
> Patients or healthcare providers can call to have an application mailed or faxed. It can also be downloaded.
Required
> Patients must complete a section and sign. Doctors must provide the patient with a prescription. The application can then be faxed and the prescription can be sent by E-Prescribe.
Supply
> Varies
Ship To
> Doctor's office or patient's home
Note
> Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s).
 
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.
 
Parnate Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
Download printable Form
(Requires Acrobat Reader