The Patient Assistance Program provides assistance to patients that cannot afford their medication and have no form of prescription drug coverage. Health care providers and their patients may apply for the program. Health care providers can initiate the application process online by selecting a drug link below. A three month supply of medication will be provided to eligible patients.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • D

    • Duexis
  • R

    • Rayos
  • V

    • Vimovo™