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Patient Assistance Information

 
2 Programs for Wellbutrin XL 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.
 
Wellbutrin XL Tablets
 
 
 
Wellbutrin XL Guarantee Program

Direct Success Pharmacy
PO Box 279
Sea Girt, NJ 08750
Phone : (800)520-3185
Fax:
Eligibility
> Insurance status will be considered on a case by case basis. Medicare Part D recipients are not eligible. Patients must meet income requirements that have not been disclosed, have a medically appropriate diagnosis/condition and must be treated by a US licensed healthcare provider.
Who Can Apply
> Patients or healthcare providers can call to apply.
Required
> Patients must call to enroll in the program.
Supply
> Not specified
Ship To
> Not specified
Note
> Eligibility determined on a case-by-case basis. Contact program for details.
 
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.
 
Wellbutrin XL Tablets