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Patient Assistance Information

 
2 Programs for Synthroid
 
 
AbbVie Patient Assistance Foundation

AbbVie Patient Assistance Foundation
PO Box 270
Somerville, NJ 08876
Phone : (800)222-6885
Fax: (866)898-1473
Eligibility
> May have private insurance; must not be government funded. Must've been denied LIS. Mustn't be eligible for Medicaid. Income requirements are based on FPL. Must reside in the US.
Who Can Apply
> Call to have application faxed, emailed, mailed or download from the website. Return application via fax or mail. Patient and Doctor are notified of decision within 5-7 business days.
Required
> Diagnosis/Medical Criteria not required. Doctor must complete and sign application. Patient must complete application, sign and provide annual income information. Proof of income required.
Supply
> Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly.
Ship To
> Ships to Doctor's office within 7-10 business days.
Note
> Those with insurance may be eligible on an exception basis.
 
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.
 
Synthroid
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form AbbVie Patient Assistance Foundation
(Requires Acrobat Reader
 
 
Patient Access Network Foundation (PAN)

PO Box 221858
Charlotte, NC 28222
Phone : (866)316-7263
Fax: (866)316-7263
Eligibility
> 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
> Patients or healthcare providers can complete the application online or by phone.
Required
> 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.
Supply
> Not applicable
Ship To
> Patient sent card to be used at pharmacy
Note
> *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.
 
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.
 
Synthroid
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader