RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center

Program Details

Teva Cares Foundation

Cyclosporine capsules (cyclosporine)
Address: PO Box 52028
Phoenix, AZ 85072-9937
Phone: 1-877-237-4881 Provider Phone:
Fax: 1-877-438-4404 Website: Program Website
Eligibility Info:
  • Patient must not have prescription coverage for the medication and meet program income guidelines which are not disclosed.
  • Each application will be considered on a case-by-case basis.
  • Income at or below: Single % FPL
      Couple % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Other Income Requirements: See chart with application instructions for income guidelines
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Physician License #
    Both DEA and State
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    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: 06/18/2019




    Application Forms
    & Instructions

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

    DocumentForm (English)


    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2019, RxVantage, all rights reserved.