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Patient Assistance Information

 
1 Program for TRILIPIX
 
 
Abbott Patient Assistance Foundation

Abbott Patient Assistance Foundation
PO Box 270
Somerville, NJ 08876
Phone : (800)222-6885
Fax: (866)898-1473
Eligibility
> The Abbott Patient Assistance Foundation provides Abbott 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 Abbott Patient Assistance Foundation’s purpose of providing products at no cost to individuals in need.
Required
> The application must be completed and signed by the patient and prescriber. Proof of income must be attached. Patient may also provide a copy of Medicare card or letter of Medicaid and/or Social Security denial, if applicable.
Supply
> 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.
Ship To
> Prescriber's office
Note
> Upon receipt of a completed application, the prescriber and patient will be notified of program 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.
 
TRILIPIX
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader