PAP Assistance Form rv0106 indd - acbhcs 2025

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Pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance or drug free product (through in-kind product donations) to low income individuals to augment any existing prescription drug coverage.
1-855-ELIQUIS (354-7847). Learn more about Prescription Coverage Assistance below.
Our Patient Assistance Programs are intended for people that live in the United States, have limited or no health insurance coverage and demonstrate qualifying financial need. In 2023, we assisted more than 218,000 people.
You may be eligible if you meet the following criteria: 1. You have an annual household income* at or below: $35,000 for a single person $48,000 for a family of two $60,000 for a family of three $70,000 for a family of four $80,000 for a family of five * Income limits may be higher in Alaska and Hawaii.
What is the Patient Access Program? The Patient Access Program, or PAP, allows a patient, the patients parent or legal guardian if the patient is a minor, or the patients legal guardian if the patient is an incapacitated person to receive a copy of the patients Texas Prescription Monitoring Program record.
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Patient Assistance Program (PAP) a program in which pharmaceutical manufacturers provide financial or medication assistance (pharmaceuticals) to low- income individuals.