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Patient Assistance Information

1 Program for HUMIRA Pre Filled Syringe
AbbVie Patient Assistance Foundation (HUMIRA)

D-617927, AP5 NE
1 N. Waukegan Rd.
North Chicago, IL 60064
Phone : 800-222-6885
Fax: 866-250-2803
> 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
> 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.
> 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).
> 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.
Ship To
> Either Doctor's office or Patient's home
> Upon receipt of a completed application, the physician and patient will be notified of PAP eligibility.
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
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Humira Patient Assistance Application
(Requires Acrobat Reader