Program Details

BOEHRINGER INGELHEIM CARES FOUNDATION, INC.
BI Cares Patient Assistance Program

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CONTACT INFO
Address: PO Box 5520
Louisville, KY 40255
Phone: 1-800-556-8317 Provider Phone:
Fax: 1-866-851-2827 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be uninsured or underinsured.
  • Patients with Medicare Part D may be eligible, contact program for details.
  • Patients must meet the established financial criteria which is different for groups of medication. See and print Eligibility Information sheet.
  •   Couple % FPL
      Credit for Dependents allowed
    Medical expenses can be deducted from reported income: No
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Prescription
    Physician License #
    Required:
    Both DEA and State
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    No
    Eligibility determination
    letter sent:
    Patient
    MEDICATION
    Receives: Medication
    Shipped To: Either Provider and Patient
    Aptivus and Viramune XR can only be shipped to the prescriber office.
    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: Not Published
    Other Information:
  • All products are registered trademarks of Boehringer Ingelheim. Program is subject to change without notice.
  • Last Updated: 12/06/2023


    www.RxAssist.org