You must be a citizen of the US.
You must be under the care of a licensed healthcare provider that is authorized to prescribe and
administer medication in the US.
You cannot have any insurance coverage or access to the desired prescription via any insurance.
You cannot be eligible for Medicare or Medicaid.
Your household income must be equal to or less than 250% of the current Federal Poverty Level.
Medications available through the patient assistance program:
Adacel (tetanus tosoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed)
Apidra (insulin glulisine [rDNA origin] injection)
Auvi-Q (epinephrine injection, USP)
Clolar (clofarabine) Injection
Imogam Rabies-HT Immune Globulin, [Human] USP, Heat Treated
Imovax Rabies Vaccine [Human Diploid Cell]
Jevtana (cabazitaxel) Injection
Lantus (insulin glargine [rDNA origin] Injection)
Lovenox (enoxaparin sodium injection)
Menactra meningococcal (Groups A, C, Y and W-135) Polysaccharide Diptheria Toxoid Conjugate Vaccine
Mozobil (plerixafor injection)
Multaq (dronedarone) Tablets
Priftin (rifapentine) Tablets
Tenivac (tetanus and diphtheria toxoids adsorbed)
Thercys (BCG live [Intravesical])
Thymoglobulin [Anit-thymocyte Globulin (Rabbit)]
Toujeo (insulin glargine [rDNA origin] injection, 300 units/mL)