Prescription Drug Patient Assistance Programs

Description: Pharmaceutical companies or pharmacies that make brand name or generic prescription drugs available to patients who are uninsured or underinsured or, for other reasons, cannot afford to pay the market price. Also included are organizations that help qualifying patients complete and file paperwork for submission to drug manufacturers to request such medication or which maintain lists of these types of programs for referral purposes. (AIRS LH-6700.6300)

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Disclaimer...
Note: Service listings do not represent a recommendation or endorsement by the Medical Home Portal staff or its sponsoring organizations; nor do they reflect any assessment of the quality or value of a listed Service.

UT

Statewide

352 South Denver Street Ste 101
Salt Lake City, UT 84111
Phone: 801-364-0366
Address: 352 South Denver Street Ste 101
Salt Lake City, UT 84111
Phone: 801-364-0366
Toll Free Phone: 800-657-6398
Fax: 801-364-0368
Email: info@utahlupus.org
Eligibility: Open to the public.
Wheelchair Accessible: Complete
Services Provided: The Lupus Foundation of America is leading efforts to find the cure for lupus and help people who are affected by the disease.
Original Source:
Last Updated: 2/5/2018
Organization Name: Utah Department of Health
Address: UT
Eligibility: low income or uninsured with prescription needs
Services Provided: A webpage compilation of resources offering prescription assistance, assembled by the Utah Department of Health.
Asthma-related support.
Original Source:
Last Updated: 2/14/2018
Organization Name: Utah Department of Health
Address: 288 North 1460 West
UT 84114
Phone: 801-538-6096
Fax: 801-538-9913
Eligibility: Individuals living with HIV disease and family members who have no insurance, are underinsured or are not eligible for a State program, assets not over $10,000 (does not include a home or one car), low income.
Services Provided: 1. Supportive Services Program - ambulatory care, dental care, transportation services, case management, mental health services, substance abuse services, outreach services, and home health care.
2. ADAP (AIDS Drug Assistance Program) - helps eligible individuals pay for all or part of their HIV medications.
3. Health Insurance Continuation Program (COBRA) - can pay for COBRA payments for eligible individuals.
Original Source:
Last Updated: 2/14/2018
Address: UT
Eligibility: Utah residents
Services Provided: Access to a Prescription Assistance Program in which residents can print free discount prescription coupons up to 75 percent in savings at more than 68,000 pharmacies. Simply follow the link and print your free coupon now to start saving on your prescription drugs.
Provider Profiles: website
Original Source:
Last Updated: 6/4/2018

Clearfield, UT

Organization Name: Midtown Community Health Centers
Address: 22 South State Street Ste 1007
Clearfield, UT 84015
Phone: 801-393-5355
Fax: 801-394-3693
Eligibility: Low income, sliding scale. Temporary Medicaid coverage for pregnant women.
Services Provided: The Davis County Medical and Dental Clinics are co-located with the Davis County Health Department. Comprehensive primary care services include treatment for acute and chronic illnesses, well care, and mental health counseling. Full dental services offered including extractions, fillings, root canals, partials, crowns, and dentures. This site also serves as the Utah Cancer Control Program for Davis County.
Provider Profiles: After-Hours Clinical Advice 801-626-2645
Original Source:
Last Updated: 9/5/2018

Logan, UT

Organization Name: Midtown Community Health Centers
Address: 272 1/2 North Main Street
Logan, UT 84321
Phone: 435-752-7060
Fax: 435-752-1672
Eligibility: Wellness programs are available to any Midtown patient; generally patients are under 200% of Federal Poverty Level, call for specific eligibility questions
Services Provided: Serves the underserved residents of Cache Valley and the surrounding areas. Opened with the support of Intermountain Healthcare to ensure that low-income and uninsured community residents have access to comprehensive primary healthcare services. Provides primary healthcare services including well care, prenatal care, pediatrics, immunizations, women’s health, geriatrics, and treatment for acute and chronic illnesses such as diabetes, hypertension, and asthma.
Original Source:
Last Updated: 9/5/2018

Moab, UT

Organization Name: Grand County Government
Address: 380 North 500 West
Moab, UT 84532
Phone: 435-259-1113
Fax: 435-259-1120
Eligibility: Open to persons 14 years old and older regardless of insurance status.
Services Provided: Providing free non-emergency medical services to improve the quality of life for uninsured or under insured families.
Original Source:
Last Updated: 9/13/2018

Ogden, UT

Organization Name: Midtown Community Health Centers
Address: 781 25th Street
James Madison Elementary School
Ogden, UT 84401
Phone: 801-393-5355
Fax: 801-394-4609
Eligibility: Services are available to all community residents, but the focus is on serving school-aged children.
Wheelchair Accessible: Complete
Services Provided: Health clinic located inside James Madison Elementary School, designed to serve the students at the school, their family members and residents in the neighborhood. Primary focus is to serve school-aged children.
Provider Profiles: (Please enter the clinic through the specified clinic/patient entrance.)
After-Hours Clinical Advice 801-626-2645
AUCH member
Original Source:
Last Updated: 9/5/2018
Organization Name: Midtown Community Health Center
Address: 237 26th Street
Ogden, UT 84401
Phone: 801-625-3700
Eligibility: CHCs serve everyone, insured and uninsured. Patients pay for services on a sliding-scale fee structure based on their income. Patients must be 18 and over with a serious and persistent mental health concern to be seen at this clinic.
Services Provided: Midtown Wellness Clinic, located at Weber Human Services, is designed to improve the physical health of individuals with mental illnesses and addictions. Comprehensive primary care services including treatment for acute and chronic illnesses, well care, mental health counseling, and medication management for mental health issues are offered.
Provider Profiles: After Hours Clinical Advice 801-626-2645
AUCH
Original Source:
Last Updated: 9/5/2018
Organization Name: Midtown Community Health Centers
Address: 2240 Adams Avenue
Ogden, UT 84401
Phone: 801-393-5355
Fax: 801-394-4609
Eligibility: CHCs serve everyone, insured and uninsured. Patients pay for services on a sliding-scale fee structure based on their income.
Wheelchair Accessible: Complete
Services Provided: Ogden Midtown Community Health Center location offers (for patients of all ages and backgrounds) comprehensive primary health care services, walk-in service (Urgent Care) for acute illnesses or minor emergencies, full dental services, lab services, minor surgery, behavioral health services/counseling, and a pharmacy offering discounted pharmaceutical and over-the-counter medications.
Provider Profiles: AUCH
Original Source:
Last Updated: 9/5/2018

Provo, UT

750 West 200 North
Provo, UT 84601
Phone: 801-357-5757
Organization Name: Intermountain Healthcare - Utah County
Address: 750 West 200 North
Provo, UT 84601
Phone: 801-357-5757
Fax: 801-357-5759
Eligibility: low income, uninsured or under insured demographic
Services Provided: The Intermountain Dixon Health Center is located on the campus of Dixon Middle School and provides general medical care for people of all ages, including low-income families or those without insurance. Includes those in need of assistance paying for their prescription of insulin.
Original Source:
Last Updated: 9/12/2018

Salt Lake City, UT

347 South 400 East
Salt Lake City, UT 84111
Phone: 801-364-7765
Address: 347 South 400 East
Salt Lake City, UT 84111
Phone: 801-364-7765
Fax: 801-364-7228
Eligibility: Adults ages 26 and older; able to lift up to 40 lbs; reliable and personable.
Wheelchair Accessible: Entry and Bathroom(s)
Services Provided: Assists and organizes low income, disabled, and minority Utahns to meet basic survival needs and to address essential issues affecting quality of life.
Original Source:
Last Updated: 9/5/2018
Organization Name: Wasatch Homeless Health Care, Inc.
Address: 400 South 409 West
Salt Lake City, UT 84101
Phone: 801-364-0058
Fax: 801-364-4602
Eligibility: Homeless individuals or families and patients with an income less than 200% of Federal Poverty Level. Insured and uninsured. Patients pay for services on a sliding-scale fee structure based on their income.
Wheelchair Accessible: Complete
Services Provided: A comprehensive medical home providing coordinated primary care, behavioral health, and pharmacy services to homeless individuals and families in the Salt Lake area.
Provider Profiles: AUCH
Original Source:
Last Updated: 9/6/2018

South Salt Lake, UT

Organization Name: Midtown Community Health Center
Address: 2253 South State Street
South Salt Lake, UT 84115
Phone: 801-486-0911
Fax: 801-486-0796
Eligibility: CHCs serve everyone, insured and uninsured. Patients pay for services on a sliding-scale fee structure based on their income.
Services Provided: Offer patients of all ages and backgrounds comprehensive primary healthcare services including well care, prenatal care, pediatrics, immunizations, women’s health, family planning, geriatrics, treatment for acute and chronic illnesses, and mental and behavioral health services. State provider for refugee services.
Provider Profiles: AUCH
Original Source:
Last Updated: 9/5/2018

St. George, UT

197 East Tabernacle Street
St. George, UT 84770
Phone: 435-634-5715
Address: 197 East Tabernacle Street
St. George, UT 84770
Phone: 435-634-5715
Fax: 435-634-5763
Services Provided: Prescription drug discount cards.
Original Source:
Last Updated: 2/14/2018

Washington Terrace, UT

Organization Name: Midtown Community Health Centers
Address: 5285 South 400 East, Ste A
Washington Terrace, UT 84405
Phone: 801-393-5355
Fax: 801-394-4609
Eligibility: Clinic serves exclusively children under age 18, insured and uninsured. Patients pay for services, including prescriptions on a sliding-scale fee structure based on their income. Medicaid, Medicare, CHIP (Children’s Health Insurance Program), PCN (Primary Care Network), most private medical insurances (please confirm when you set an appointment)
Wheelchair Accessible: Complete
Services Provided: Midtown Children's Clinic is exclusively for children (birth-18 years), providing well-child visits, immunizations, and treatment for acute illnesses. Experienced in caring for children with chronic illnesses and special needs.
Provider Profiles: After-Hours Clinical Advice 801-626-2645

AUCH
Trained in the medical home model 6/18/2011 - 12/31/2014.
Original Source:
Last Updated: 9/5/2018

Nationwide

P.O. Box 29038
Phoenix, AZ 85038-9038
Address: P.O. Box 29038
Phoenix, AZ 85038-9038
Toll Free Phone: 866-728-4368
Eligibility: Patients must live in one of the 50 states or the District of Columbia; have no prescription drug benefits through any insurer/payer/program; have gross monthly household income at or below certain levels.
Services Provided: Bridges to Access is GlaxoSmithKline's patient assistance program that provides GSK non-oncology medicines—at no cost—to qualified patients.
Original Source:
Last Updated: 7/30/2018
Irving, TX 75063
Phone: 877-321-2652
Address: Irving, TX 75063
Phone: 877-321-2652
Toll Free Phone: 877-321-2651
Eligibility: Call or visit website for information on participating counties.
Services Provided: Provides up to 24% off the pharmacy's regular price on all commonly prescribed prescriptions. Savings are also available on specialty medications (high-tech and injectable drugs), mail order as well as pet medications.
Original Source:
Last Updated: 3/28/2018
1720 Spillman Drive Ste 100
Bethlehem, PA 18015
Phone: 866-810-3784
Organization Name: FamilyWize Community Service Partnership
Address: 1720 Spillman Drive Ste 100
Bethlehem, PA 18015
Phone: 866-810-3784
Eligibility: No restirctions
Services Provided: Provides a prescription drug discount card at no cost. The FamilyWize card can also be used for pet medications.
Original Source:
Last Updated: 8/14/2018
Address: 6900 N. Dallas Parkway, Suite 200
Plano, TX 75024
Phone: 877-968-7233
Fax: 214-570-3621
Email: info@cdfund.org
Eligibility: Patients suffering from chronic medical conditions who have limited financial means.
Services Provided: Helps patients get access to the medications they need, pay insurance co-pays, transportation, insurance premiums, finding insurance coverage, and emotional support.
Provider Profiles: Hours: 8:00 a.m. to 5:00 p.m. CST
Original Source:
Last Updated: 9/12/2018
Address:
Services Provided: A website to search for lowest price prescription drugs based on location. Offers coupons, will send refill reminders and alerts when prices change.
Original Source:
Last Updated: 4/25/2018
PO Box 4133
Gaithersburg, MD 20885-4133
Phone: 800-675-8416
Address: PO Box 4133
Gaithersburg, MD 20885-4133
Phone: 800-675-8416
Fax: 800-282-7692
Eligibility: Patients living with chronic and life-altering illnesses. Must meet income and diagnosis requirements. Call for specific information.
Services Provided: Provides financial assistance to eligible individuals to cover coinsurance, copayments, health care premiums and deductibles for certain medications and therapies.
Original Source:
Last Updated: 2/13/2018
Address: 6645 West North Avenue
Oak Park, IL 60302
Phone: 708-383-0808
Toll Free Phone: 800-362-4423
Eligibility: Children with endocrine disorders.
Services Provided: The Magic Foundation provides information, resources, and an insurance and appeals assistance program, designed to assist members in the insurance appeals process as funding allows. Programs include: Pharmaceutical Company Patient Assistance Programs, Co-Pay Assistance Foundation, Insurance Appeals.
Provider Profiles: An organization of parents of children with endocrine disorders.
Original Source:
Last Updated: 8/1/2018
Address:
Eligibility: Low income and relatively few assets, reside in one of the 50 States or the District of Columbia.
Services Provided: Although pharmacy coverage is an optional benefit under federal Medicaid law, all states currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their state Medicaid programs.
Original Source:
Last Updated: 8/1/2018
PO Box 515
Doniphan, MO 63935-0515
Phone: 573-996-7300
Address: PO Box 515
Doniphan, MO 63935-0515
Phone: 573-996-7300
Toll Free Phone: 888-812-5152
Email: help@themedicineprogram.com
Eligibility: No prescription insurance coverage, applicant does not qualify for a government program, patient's income at a level to cause hardship if purchasing retail.
Services Provided: Our function, in cooperation with the physician, is to assist patients who may qualify to enroll in one or more of the many patient assistance programs now available. These programs provide prescription medicine free-of-charge to individuals in need, regardless of age, if they meet the sponsor's criteria.
Provider Profiles: $5 fee for processing each medication requested
Original Source:
Last Updated: 5/31/2018
Address: Danbury, CT
Toll Free Phone: 800-634-7207
Services Provided: The National Organization for Rare Disorders (NORD), a 501(c)(3) organization, is a unique federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. NORD is committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and service. Co-pay Assistance Program.
Patient Assistance Program, RareCare: helps patients obtain life-saving or life-sustaining medication they could not otherwise afford. These programs provide medication, financial assistance with insurance premiums and co-pays, diagnostic testing assistance, and travel assistance for clinical trials or consultation with disease specialists.
Original Source:
Last Updated: 2/13/2018
PO Box 382377
Birmingham, AL 35238
Phone: 800-334-8134
Organization Name: Prescription Benefits, Inc.
Address: PO Box 382377
Birmingham, AL 35238
Phone: 800-334-8134
Fax: 205-980-2354
Email: generalinfo@rxbenefits.com
Services Provided: Nationwide provider of discount pharmacy cards for individuals, families, and seniors.
Original Source:
Last Updated: 2/20/2018
PO Box 219
Gloucester, MA 01931
Phone: 800-503-6897
Address: PO Box 219
Gloucester, MA 01931
Phone: 800-503-6897
Fax: 206-260-8850
Eligibility: There are no income, insurance, age, or residency requirements.
Services Provided: NeedyMeds is an online information resource of programs that provide assistance to people who are unable to afford their medications and health care costs. Does not provide medicine, supplies of financial assistance. Offers applications and information so that people can apply directly to drug manufacturers and other organizations that provide assistance. The application process is strictly between the applicant and the manufacturer. All of the information on the website is at no cost and is updated daily.
Provider Profiles: 90 day w refills. Turnaround 3-4 weeks; physician sends in prescription
Original Source:
Last Updated: 9/12/2018
Washington, DC 20004
Phone: 888-477-2669
Address: Washington, DC 20004
Phone: 888-477-2669
Eligibility: Qualifying patients without prescription insurance
Services Provided: Online access to more than 475 public and private programs, including nearly 200 offered by biopharmaceutical companies, helping Americans get free or reduced-cost prescription medicines. Co-pay assistance for pharmaceuticals.
Original Source:
Last Updated: 2/13/2018
1331 F Street NW Ste 975
Washington, DC 20004
Phone: 202-347-9272
Organization Name: PAN Foundation
Address: 1331 F Street NW Ste 975
Washington, DC 20004
Phone: 202-347-9272
Eligibility: People with chronic or life-threatening illnesses, financial assistance for out-of-pocket costs.
Services Provided: Offers help and hope to people with chronic or life-threatening illnesses for whom cost limits access to breakthrough medical treatments.
Provider Profiles: Call or visit website.
Original Source:
Last Updated: 4/17/2018
421 Butler Farm Road
Hampton, VA 23666
Phone: 866-512-3861
Organization Name: Patient Advocate Foundation
Address: 421 Butler Farm Road
Hampton, VA 23666
Phone: 866-512-3861
Toll Free Phone: 800-532-5274
Fax: 757-952-0119
Eligibility: Existence of insurance coverage for pharmaceuticals (including Medicare Part D coverage). Qualifying income. Qualifying diagnosis verified by physician of conditions such as breast, lung, lymphoma, prostate, kidney, colon, pancreatic, head/neck cancers, malignant brain tumor, sarcoma, diabetes, multiple myeloma, myelodysplastic syndrome (and other pre-leukemia diseases) osteoporosis, pain, hepatitis C rheumatoid arthritis, selected autoimmune disorders and CIA/CIN.
Services Provided: Co-pay assistance for pharmaceuticals.
Includes mental retardation and developmental disabilities.

Qualifying diagnosis verified by physician of conditions such as breast, lung, lymphoma, prostate, kidney, colon, pancreatic, head/neck cancers, malignant brain tumor, sarcoma, diabetes, multiple myeloma, myelodysplastic syndrome (and other pre-leukemia diseases) osteoporosis, pain, hepatitis C, rheumatoid arthritis, selected autoimmune disorders and CIA/CIN.
Original Source:
Last Updated: 3/15/2018
Organization Name: National Alliance for the Mentally Ill (NAMI)
Address: 3803 N Fairfax Dr., Ste. 100
Arlington, VA 22203
Phone: 703-524-7600
Fax: 703-524-9094
Eligibility: Differs by specific pharmaceutical company.
Services Provided: Provides a list of pharmaceutical companies that offer medications through medication assistance programs to low-income individuals and families.
Provider Profiles: Internet-based resource
Original Source:
Last Updated: 8/20/2018
Address: PO Box 5930
Midlothian, VA 23112
Phone: 800-366-7741
Toll Free Phone: 800-366-7741
Fax: 804-744-9388
Eligibility: Financial assistance for insured and uninsured patients with chronic illnesses.
Services Provided: Provides online disease and treatment information as well as financial assistance for patients with chronic illnesses who are struggling to keep up with expensive premiums and copayments. Available programs and specific illnesses are regularly updated. Financial assistance includes: subsidizing the cost of health insurance premiums; providing pharmacy and treatment copayment assistance; assisting with Medicare Part D co-insurance; providing travel assistance for transportation reimbursement.
Provider Profiles: Online resources
Original Source:
Last Updated: 8/1/2018
127 Main Street 2nd Floor
Black Hawk, CO 80422
Phone: 888-670-0039
Address: 127 Main Street 2nd Floor
Black Hawk, CO 80422
Phone: 888-670-0039
Fax: 720-287-6523
Eligibility: Open to the public.
Services Provided: Helps consumers of prescription drugs save money at the retail pharmacy ranging from 10% to 85% depending on the type of drug you choose. Also offers valuable information on programs to help you with free medication through the Patient Assistance Partners.
Original Source:
Last Updated: 2/20/2018
Address:
Email: info@rxassist.org
Eligibility: Low income families
Services Provided: RxAssist offers a comprehensive database of prescription assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. Directory of patient assistance programs for free and low cost medicine for low income families. Site requires free registration.
Provider Profiles: Internet Resource

Sponsored by ASTRA-ZENECA.
Original Source:
Last Updated: 7/30/2018
Address:
Eligibility: Low-income. Eligibility guidelines may vary by the drug manufacturer.
Services Provided: Provides low-income US residents with information and free or low cost prescriptions through their health care professionals. This is an online service only. Addresses and telephone numbers will vary depending upon the specific drug and manufacturer desired.
Original Source:
Last Updated: 5/30/2018
9700 Health Care Lane
PO Box 41
Minnetonka, MN 55343
Address: 9700 Health Care Lane
PO Box 41
Minnetonka, MN 55343
Toll Free Phone: 855-698-4223
Eligibility: Parents of children receiving serious and financially-challenging health care treatment. 16 and under nationwide for medical services not covered or not fully covered by insurance. Live in US, covered by a commercial health insurance plan.
Services Provided: Provides grants, up to $5,000, for families who have children with critical healthcare treatment, services, or equipment not covered or not fully covered by their parents' health benefit plans to help pay for child health care services such as speech therapy, physical therapy, occupational therapy sessions, prescriptions, and medical equipment such as wheelchairs, orthotics, and eyeglasses. Co-pay assistance for pharmaceuticals.
Provider Profiles: See additional criteria and exclusions on website.
Original Source:
Last Updated: 9/6/2018
Address:
Services Provided: Walmart is offering $4 prescriptions for some generic medications.
Original Source:
Last Updated: 7/10/2018