You must not be covered by any private, public, or Medicare Part D health insurance and prescription
You must be a citizen of the United States or its Territories.
You must be an outpatient currently under the care of a physician.
Your income must be less than or equal to 200% of the Federal Poverty Guideline (300% for BiDil) for the size of your household.
|Each additional Person||$8,040|
Medications covered by the Patient Assistance Program:
EryPed 200 Oral Suspension
EryPed 400 Oral Suspension
EryPed Chewable Tablet
Erythrocin Stearate Filmtab Tablet
Erythromycin Delayed-Release Capsules
Erythromycin Ethylsuccinate Oral Suspension
PCE Dispertab Tablets