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Horizon Patient Assistance Program
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Horizon Patient Assistance Program
PO Box 42886
Cincinnati, OH 45242
Phone
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(866)247-2228
Fax:
(513)338-8246
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Eligibility
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The Patient Assistance Program provides assistance to patients that cannot afford their medication and have no form of prescription drug coverage. Annual household income limits do apply but each case is reviewed on an individual basis. Patients must reside in the U.S. and be under the care of a U.S. based physician. |
| Who Can Apply
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Healthcare Providers and their patients may apply for the program. Healthcare Providers can initiate the application process online by selecting a drug link below or by calling 866-247-2228. |
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Required
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The application must be completed and signed by the healthcare provider and patient. Documentation of the patient's current gross annual household income must accompany the application. |
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Supply
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A three month supply of medication will be provided to eligible patients. |
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Ship To
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All medication will be shipped to the healthcare provider's office. |
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Note
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After one year of enrollment, the application process must be completed again, including documentation of the patient's current gross annual household income.
DUEXIS Prescribing Information
DUEXIS Medication Guide
PENNSAID Prescribing Information
PENNSAID Medication Guide
RAYOS Prescribing Information
VIMOVO Prescribing Information
VIMOVO Medication Guide
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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.
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| RAYOS |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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Patient Access Network Foundation (PAN)
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PO Box 221858
Charlotte, NC 28222
Phone
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(866)316-7263
Fax:
(866)316-7263
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Eligibility
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This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. |
| Who Can Apply
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Patients or healthcare providers can complete the application online or by phone. |
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Required
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Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received. |
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Supply
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Not applicable |
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Ship To
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Patient sent card to be used at pharmacy |
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Note
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*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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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.
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| RAYOS |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| (Requires Acrobat Reader)
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Rayos Co-Pay Savings Program
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,
Phone
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855-226-4006
Fax:
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Eligibility
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The Rayos Co-Pay Savings Program provides assistance to patients that can not afford their co-pay for Rayos. Patients with insurance are eligible. Patients with Medicare Part D are eligible if the medication is not covered by their plan. |
| Who Can Apply
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Patients that have been prescribed Rayos that are in need of co-pay assistance. |
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Required
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Patients who are eligible can apply online by completing an online enrollment form. |
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Supply
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Not sepcified |
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Ship To
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Medication is shipped to the patient's home. |
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Note
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Eligible patients pay as little as $0 for their RAYOS therapy. |
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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.
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| RAYOS |
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