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TEVACares Foundation Patient Assistance Program
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PO Box 52028
Phoenix, AZ 85072
Phone
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877-237-4881
Fax:
877-438-4404
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Eligibility
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Patients must have no prescription coverage for the needed medication, including Medicare Part D. Income requirements for this program are based on the Federal Poverty Level. Patients must be a citizen or US resident. |
Who Can Apply
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Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded. |
Required
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Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income. |
Supply
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Varies |
Ship To
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Doctor's office or patient's home |
Note
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The CephalonCares Foundation Patient Assistance Program for Fentora, Gabitril, Nuvigil and Tev-Tropin and the TEVA Assistance Program are now known as the TEVA Cares Foundation Patient Assistance Program.
Contact program for Spanish application. |
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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. |
QNASL aerosol; nasal |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
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