Program Details

TEVA PHARMACEUTICALS
Teva Cares Foundation

Cyclosporine capsules (cyclosporine)
 
CONTACT INFO
Address: PO Box 16130
Columbus, OH 43216
Phone: 1-877-237-4881 Provider Phone:
Fax: 1-877-438-4404 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must not have prescription coverage for the medication and meet program income guidelines which are not disclosed.
  • Patients with Medicare Part D are not eligible.
  • Call for current medication list as is subject to change.
  •   Couple % FPL
    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: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Either Provider and Patient
    Quantity in Shipment: Varies by medication
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Reorder form must be sumbitted
    Other Information:

    Last Updated: 11/28/2023


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