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Actavis patient assistance program

Actavis patient assistance program 2025

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The document is an application form for the Actavis Patient Assistance Program, which provides medications and devices at no charge to qualifying applicants. It includes sections for licensed prescriber information, patient details, income information, and certifications required from both the patient and prescriber. The program aims to assist individuals who cannot afford their prescribed medications, with specific eligibility criteria and documentation requirements outlined.

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Click ‘Get Form’ to open the Actavis Patient Assistance Program application in the editor.
Begin with Section 1.0: Licensed Prescriber Information. Fill in the prescriber's first name, last name, professional designation, and contact details. Ensure to attach a valid prescription for the requested medication.
Proceed to Section 2.0: Patient Information. Enter the patient's legal name, date of birth, gender, and contact information. Confirm citizenship status and provide household details.
In Section 2.1: Income Information, list all sources of income accurately to determine eligibility.
Complete Section 2.2: Other Coverage Information by indicating any existing insurance coverage and attaching necessary documentation like Medicare Part D LIS denial letters if applicable.
Sign and date Section 3.0: Patient Certification to confirm all information is accurate and complete.
Finally, ensure that the licensed prescriber completes Section 4.0 and signs it before submitting the application along with all required documents.

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Is Actavis a pharmaceutical company?

Actavis (NYSE: ACT) is a global, integrated specialty pharmaceutical company focused on developing, manufacturing and distributing generic, brand and biosimilar products. The Company has global headquarters in Dublin, Ireland and Administrative Headquarters in Parsippany, New Jersey, USA.

What is the patient assistance program?

Patient Assistance Program is a needs-based program assists patients in accessing . Programs include copay assistance for patients with commercial insurance coverage and a need- based support program for those patients without commercial insurance. Up to $12,000 per year Product Copay Program.

Who is eligible for the patient assistance program?

Be a US citizen or legal resident. Have a total household income at or below 400% of the federal poverty level. Must be uninsured, or have Medicare. Note: if you have private or commercial insurance, you are not eligible for the PAP.

Who qualifies for the AbbVie assistance program?

This program supports patients who: Are being treated by a licensed U.S. health care provider on an outpatient basis and prescribed an AbbVie medicine that is included in our assistance program. Have limited or no health insurance coverage. Demonstrate qualifying financial need.

Is the patient assistance program legit?

If youre struggling with prescription drug costs, PAPs can help you afford medication whether you have health insurance or not. Pharmaceutical companies, nonprofit organizations, and government agencies, provide this type of financial assistance. Some programs offer complete coverage, while others give you a discount.

actavis patient assistance form

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What is the Actavis patient assistance program?

Actavis Pharma, Inc. Patient Assistance Program provides certain Actavis products to patients in the United States who are unable to afford the cost of their medication and who meet other eligibility requirements.

Who is eligible for the GSK patient assistance program?

You might be eligible for this program if the following are true: You are uninsured OR have Medicare and meet other program requirements. You live in the United States or Puerto Rico (or US Islands for certain medicines) You meet financial income eligibility criteria.