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Program Details

AbbVie
AbbVie Patient Assistance Foundation

Tricor (fenofibrate)
 
CONTACT INFO
Address: PO Box 270
Somerset, NJ 08876
Phone: 1-800-222-6885 Provider Phone:
Fax: 1-866-898-1473 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • The Abbott Patient Assistance Program is designed to help financially disadvantaged individuals receive a limited supply of Abbott pharmaceutical products at no cost.
  • To be eligible for this program, patients must not have prescription drug coverage for the requested medication through an employer other third party payer, Medicaid or any other state or federally-funded program, and must be financially disadvantaged based upon current Federal Poverty Guidelines adjusted for household size.
  • Patients with prescription drug coverage, including enrollment in a Medicare Part D Prescription Drug Plan, who have difficulty accessing their Abbott medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program exception based on health-related expenditures and household income.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: Financial
    In some cases, a Medicaid denial letter may be required.
    Physician License #
    Required:
    Either DEA or State license required along with expiration date.
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Provider
    MEDICATION
    Receives: Medication
    Shipped To: Provider
    Quantity in Shipment: 90 days
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: It is the responsibility of the physician or office staff to contact Abbott 3 weeks prior to the patient requiring further medication.
    Other Information:

    Last Updated: 06/02/2014

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Instructions (English)


    Document HIV Common Application



     

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