Contact info
- Phone
- 1-800-545-6962
- Fax
- 1-844-431-6650
- Mailing address
- PO Box 501847San Diego, CA 92150
Eligibility
- Patient must be uninsured or have Medicare Part D.
- Patients may be eligible if insurance does not cover their medication. Contact program for details.
- Patients must not be eligible for or enrolled in Medicaid or Veterans Administration Benefits.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Other income rules
- Income limits vary by medication. Refer to application for income guidelines.
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- DEA number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider or patient
- Supply per shipment
- Up to a 120-day supply
- Time to first delivery
- Not published
- Refills
- Contact program
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Basaglar (insulin glargine injection)
- Cialis (tadalafil)
- Cyramza (ramucirumab injection)
- Ebglyss (lebrikizumab-lbkz)
- Emgality injection (galcanezumab-gnlm)
- Erbitux (cetuximab)
- Forteo (teriparatide)
- Humalog Injection (insulin lispro injection)
- Humalog KwikPen (insulin lispro injection)
- Humalog KwikPen Mix 50/50 (insulin lispro injection (rDNA))
- Humalog KwikPen Mix 75/25 (insulin lispro injection (rDNA))
- Humalog Mix 50/50 (50% Insulin Lispro Protamine Suspension, 50% Insulin Lispro Injection (rDNA))
- Humalog Mix 75/25 (human insulin lispro (rDNA))
- Humatrope (somatropin (rDNA origina) for injection)
- Humulin 70/30 (isophane human insulin (rDNA); human insulin (rDNA))
- Humulin N Injection (NPH human insulin (rDNA))
- Humulin R Injection (Regular human insulin (rDNA))
- Humulin R U-500 Injection; Concentrated (regular insulin human [rDNA Origin])
- Inluriyo (imlunestrant)
- Jaypirca (pirtobrutinib)
- Kisunla (donanemab-azbt)
- Lyumjev (insulin lispro-aabc injection)
- Olumiant (baricitinib)
- Omvoh infusion (mirikizumab-mrkz)
- Omvoh injection (mirikizumab-mrkz)
- Retevmo (selpercatinib)
- Reyvow (lasmiditan)
- Taltz (ixekizumab)
- Trulicity (dulaglutide)
- Verzenio (abemaciclib)