You must be a US resident.

You cannot have private or public prescription coverage.

Income Guidelines:

No specific income guidelines were provided by the company but income documentation is required as

part of the application. It can be assumed your income must be at or below the federal poverty line.

Medications covered by the Patient Assistance Program:

Arcapta Neohaler (indacaterol inhalation powder)

Clozaril (clozapine)

Coartem tablet (artmether and lumefantrine)

Exelon Patch (rivastigmine transdermal system)

Extavia (interferon beta-1b)

Focalin XR (dexmethylphenidate hcl)

Gilenya (fingolimod)

Hecoria (tacrolimus)

Ilaris (canakinumab)

Lamisil Oral Granules (terbinafine hydrochlorid)

Myfortic (mycophenolic acid)

Neoral (cyclosporine)

Omnitrope (somatropin [rDNA origin] for injection)

Reclast (zolendronic acid)

Sandimmune (cyclosporine)

Tegretol (carbamazepine)

Tegretol XR (carbamazepine extended release)

Tekturna (aliskiren)

Tekturna HCT (aliskiren and hydrochlorothiazide)

Tobi (tobramycin)

TOBI Podhaler (tobramycin inhalation powder)

Trileptal (oxcarbazepine)

Tyzeka (telbivudine)

Zortress (everolimus)

Phone: (706) 208 9700   Mail: