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Flomax drug assistance program

Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.   Program 1 of 3.
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Spiriva HandiHaler

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Boehringer Ingelheim Cares Foundation Patient Assistance Program

This program provides brand name medications at no or low cost </@if>

Provided by: Boehringer Ingelheim Cares Foundation, Inc.

PO Box 66745
St. Louis, MO 63166-6745

TEL: 800-556-8317


FAX: 866-851-2827 Languages Spoken:

EnglishOthers By Translation Service

Program Website

 

Program Applications and Forms

Boehringer Ingelheim Cares Application

Boehringer Ingelheim Cares Application (Spanish)

HIV Common Application: Boehringer Ingelheim Cares (APTIVUS, flomax VIRAMUNE XR)

 

Medications

  • Spiriva HandiHaler powder; inhalation (tiotropium bromide)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage Those with Part D Eligible? Yes, but contact program for details Income Based on FPL Diagnosis/Medical Criteria Not specified US Residency Required? Must be a US resident    

Application

Obtaining Call or download Receiving Faxed, mailed or downloaded from website Returning Fax or mail from Doctor's office Doctor's Action Complete section, sign, attach required documents Applicant's Action Complete section, sign, attach proof of income and other requested documentation Decision Communicated Not specified Decision Timeframe Not specified    

Medication

Amount/Supply Up to 90 day supply Sent To Patient's home, unless otherwise noted Delivery Time Not specified Refill Process Patient or Doctor's office needs to contact company Limit Not specified Re-application New application yearly    

Additional Information

Eligibility determined on a case-by-case basis based on eligibility criteria.
Some Medicare eligible patients who have difficulty meeting their Part D drug costs and who do not qualify for other assistance may be eligible.

For Gilotrif, patient must not use this programs application. Please contact the BI Cares Foundation Gilotrif Patient Assistance Program at 877-814-3915.

Updated July 05, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.   Program 2 of 3.
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Spiriva HandiHaler

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Patient Access Network Foundation (PAN)

This is a copay assistance program </@if>

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261 Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

 Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • Spiriva HandiHaler powder; inhalation (tiotropium bromide)
 

Eligibility Requirements   

Insurance Status See Additional Information section below Those with Part D Eligible? Determined case by case Income Between 400-500% of FPL Diagnosis/Medical Criteria Medically appropriate condition/diagnosis US Residency Required? Must reside and receive treatment in US    

Application

Obtaining Call or complete online Receiving Complete online or by phone Returning Complete online or by phone Doctor's Action Will be discussed with patient and Doctor after request is received Applicant's Action Call for information or inform doctor that he/she is in need Decision Communicated Patient and Doctor notified in writing Decision Timeframe Within 48 hours    

Medication

Amount/Supply Not applicable Sent To Patient sent card to be used at pharmacy Delivery Time Once approved; shipped same day Refill Process Patient presents voucher/card to pharmacy for each refill Limit None Re-application New application every 12 months    

Additional Information

Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated June 29, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.   Program 3 of 3.

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Spiriva HandiHaler

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Hospital-to-Home Program

For Healthcare Professionals Only </@if>

Provided by: Boehringer Ingelheim Pharmaceuticals, Inc. and Eagle Pharmaceuticals


TEL: 844-752-5145


FAX: 877-816-5528 Languages Spoken:

English

Program Website

 

Program Applications and Forms

Hospital-to-Home Program Enrollment Form

 

Medications

  • Spiriva HandiHaler powder; inhalation (tiotropium bromide)
 

Eligibility Requirements   

Insurance Status See Additional Information section below Those with Part D Eligible? Not specified Income Not disclosed Diagnosis/Medical Criteria FDA-approved diagnosis US Residency Required? Yes    

Application

Obtaining Health care provider must complete online Receiving Must apply online Returning Fax or E-Prescribe online Doctor's Action Enroll in program, complete form and obtain patient consent Applicant's Action Inform Doctor that he/she is in need Decision Communicated Doctor notified Decision Timeframe Decision made during enrollment process    

Medication

Amount/Supply 30 day supply Sent To Patient's home Delivery Time Shipped next business day Refill Process Patient contacts pharmacy Limit Not specified Re-application Not specified    

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

Health Care Providers must enroll the patient into the program prior
to processing the Hospital-to-Home Program Copay Card.

Patient will receive a Free Starter Kit: 30 Days supply, a copay card and Information on COPD.

Updated July 05, 2017



Source: http://www.needymeds.org/drug_list.taf?_function=name&name=Spiriva%20HandiHaler


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