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Patient Assistance Information

 
 
 
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.
 
Gengraf capsule
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