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Horizon Patient Assistance Program
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Horizon Patient Assistance Program
PO Box 42886
Cincinnati, OH 45242
Phone
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(866)247-2228
Fax:
(513)338-8246
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Eligibility
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The Patient Assistance Program provides assistance to patients that cannot afford their medication and have no form of prescription drug coverage. Annual household income limits do apply but each case is reviewed on an individual basis. Patients must reside in the U.S. and be under the care of a U.S. based physician. |
| Who Can Apply
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Healthcare Providers and their patients may apply for the program. Healthcare Providers can initiate the application process online by selecting a drug link below or by calling 866-247-2228. |
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Required
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The application must be completed and signed by the healthcare provider and patient. Documentation of the patient's current gross annual household income must accompany the application. |
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Supply
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A three month supply of medication will be provided to eligible patients. |
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Ship To
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All medication will be shipped to the healthcare provider's office. |
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Note
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After one year of enrollment, the application process must be completed again, including documentation of the patient's current gross annual household income.
DUEXIS Prescribing Information
DUEXIS Medication Guide
PENNSAID Prescribing Information
PENNSAID Medication Guide
RAYOS Prescribing Information
VIMOVO Prescribing Information
VIMOVO Medication Guide
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| DUEXIS |
| PENNSAID |
| RAYOS |
| VIMOVO |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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Duexis Savings Plus Program
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520 Lake Cook Road Suite 520
Deerfield, IL 60015
Phone
:
855-250-6335
Fax:
614-652-7041
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Eligibility
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The Duexis Savings Plus Program provides assistance to patients that can not afford their co-pay for Duexis. Patients with Medicare Part D are not eligible. Income requirements for this program are not disclosed. |
| Who Can Apply
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There is no application necessary form this program. Patients must inform their physician that they are unable to afford their medication co-pay. |
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Required
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A prescription from a physician is required. |
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Supply
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Medication will be supplied by the pharmacy. |
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Ship To
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Note
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The DUEXIS Savings Plus Program is not valid for prescriptions reimbursed in whole or in part by Medicaid, Medicare, or other federal or state programs (including state prescription drug programs).
Patients will pay as little as $0 per fill with a maximum savings of up to $525 per 30-day-supply prescription.
Healthcare Professionals can request Free Samples by calling (901) 578-3200 |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| DUEXIS |
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Rayos Co-Pay Savings Program
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,
Phone
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855-226-4006
Fax:
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Eligibility
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The Rayos Co-Pay Savings Program provides assistance to patients that can not afford their co-pay for Rayos. Patients with insurance are eligible. Patients with Medicare Part D are eligible if the medication is not covered by their plan. |
| Who Can Apply
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Patients that have been prescribed Rayos that are in need of co-pay assistance. |
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Required
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Patients who are eligible can apply online by completing an online enrollment form. |
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Supply
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Not sepcified |
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Ship To
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Medication is shipped to the patient's home. |
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Note
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Eligible patients pay as little as $0 for their RAYOS therapy. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| RAYOS |
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Horizon UCD Support Services
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,
Phone
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855-823-7878
Fax:
877-695-8304
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Eligibility
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The Horizon UCD Support Services program is for patients that have no prescription coverage, have reached a cap, or cannot afford the co-payment. Patients with Medicare Part D are eligible if the medication is not covered by their plan. The patient must be a resident of the US. Patients must have a Urea Cycle Disorder (UCD). |
| Who Can Apply
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Patients and doctors can apply by obtaining an application by phone or by downloading from the link below. |
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Required
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The application must be completed and signed by the physician and patient. A copy of the patients insurance information must be attached. |
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Supply
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Supply varies. |
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Ship To
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Medication is shipped to the patient's home and patient will contact the pharmacy for re-fills. |
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Note
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Buphenyl powder |
| Buphenyl tablet |
| Ravicti liquid |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| Download printable Form |
| Download printable Form |
| (Requires Acrobat Reader)
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COMPASS Sharps Container Program
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Phone
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877-305-7704
Fax:
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Eligibility
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The COMPASS Sharps Container Program is for patients that are US residents and must have a medically appropriate condition/diagnosis. |
| Who Can Apply
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Patients |
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Required
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Patients can call to apply. |
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Supply
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One container will be supplied to the patient. |
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Ship To
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The container will be shipped to the patients home. |
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Note
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The COMPASS program will provide patients with a sharps container with a return label for easy disposal of used syringes at no cost to the patients. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Actimmune disposal container |
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