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SP-Cares
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PO Box 52122
Phoenix, AZ 85072
Phone
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800-656-9485
Ext OPT 1
Fax:
800-995-9620
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Eligibility
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The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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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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| Asmanex Twisthaler Inhalation Powder |
| Avelox Tablets |
| Cipro XR Tablets |
| Diprolene Lotion (betamethasone dipropionate) |
| Diprolene Ointment (betamethasone dipropionate) |
| Elocon Cream (mometasone furoate) |
| Elocon Lotion (mometasone furoate) |
| Elocon Ointment (mometasone furoate) |
| Foradil Powder for Inhalation |
| K-Dur Tablets |
| Lotrisone Cream |
| Lotrisone Lotion |
| Nasonex Nasal Spray |
| Nitro-Dur Patch |
| Proventil HFA Inhaler |
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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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