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Patient Assistance Information

Horizon Patient Assistance Program

Horizon Patient Assistance Program
PO Box 42886
Cincinnati, OH 45242
Phone : (866)247-2228
Fax: (513)338-8246
> The Patient Assistance Program provides assistance to patients that cannot afford their medication and have no form of prescription drug coverage. Annual household income limits do apply but each case is reviewed on an individual basis. Patients must reside in the U.S. and be under the care of a U.S. based physician.
Who Can Apply
> Healthcare Providers and their patients may apply for the program. Healthcare Providers can initiate the application process online by selecting a drug link below or by calling 866-247-2228.
> The application must be completed and signed by the healthcare provider and patient. Documentation of the patient's current gross annual household income must accompany the application.
> A three month supply of medication will be provided to eligible patients.
Ship To
> All medication will be shipped to the healthcare provider's office.
> After one year of enrollment, the application process must be completed again, including documentation of the patient's current gross annual household income.

DUEXIS Prescribing Information
DUEXIS Medication Guide
PENNSAID Prescribing Information
PENNSAID Medication Guide
RAYOS Prescribing Information
VIMOVO Prescribing Information
VIMOVO Medication Guide
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.
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Application Form
(Requires Acrobat Reader