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AbbVie Patient Assistance Foundation
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AbbVie Patient Assistance Foundation
PO Box 270
Somerville, NJ 08876
Phone
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(800)222-6885
Fax:
(866)898-1473
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Eligibility
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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
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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. |
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Required
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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. |
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Supply
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Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Ships to Doctor's office within 7-10 business days. |
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Note
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Those with insurance may be eligible on an exception basis. |
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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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| Gengraf capsule |
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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 AbbVie Patient Assistance Foundation |
(Requires Acrobat Reader) 
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