rxhelp360.org
| Drug Information | ||||||||||||||||||||||||||
| Drug | Corzide | |||||||||||||||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||||||||||||||
| Program | King Pharmaceuticals, Inc. PAP | |||||||||||||||||||||||||
| Company | King Kare | |||||||||||||||||||||||||
| Form | Download PDF | |||||||||||||||||||||||||
| Address | PO Box 608 Somerville, NJ 08876 | |||||||||||||||||||||||||
| Phone | 866-734-7366 | |||||||||||||||||||||||||
| Program Details | ||||||||||||||||||||||||||
| Details | Up to a 90-day supply is sent to the doctor's office. A new application is needed for each refill. Once a year a new application with financial documentation is needed. | |||||||||||||||||||||||||
| Program Requirements | ||||||||||||||||||||||||||
| Information | The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income. | |||||||||||||||||||||||||
| Details | Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero incomeNOT required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy NOT required as proof of income Letter from employer required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement NOT required as proof of income Award Letter for Alimony/Child Support, Unemployment NOT required as proof of income Notarized statement from patient stating zero income required as proof of income | |||||||||||||||||||||||||
| Delivery of Medication | ||||||||||||||||||||||||||
| Ship Time | 4 weeks | |||||||||||||||||||||||||
| Delivery Options | Can be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card | |||||||||||||||||||||||||
| Application Process | ||||||||||||||||||||||||||
| App Process | Anyone with the patient's and the doctor's information can call. The application is faxed to the doctor's office. The completed application must be mailed back. If the patient is denied, both patient and doctor are notified. The estimated timeline is 2-4 business days. The medication is usually shipped within 7-10 business days. | |||||||||||||||||||||||||
| New Applications | New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can apply for a new application via phone Can apply for a new application via fax Can NOT apply for a new application via mail | |||||||||||||||||||||||||
| Refills | Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can apply for refills via phone Can apply for refills via fax Can NOT apply for refills via mail | |||||||||||||||||||||||||
| Re-Applications | Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can Re-Apply via phone Can Re-Apply via fax Can NOT Re-Apply via mail | |||||||||||||||||||||||||
| Appeals | Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals NOT accepted Patients can apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can apply via fax Can NOT apply for an appeal via mail | |||||||||||||||||||||||||
| Eligibility | ||||||||||||||||||||||||||
| Eligibility | The patient must have no prescription coverage for any medications and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. See the application for specific information about the income guidelines. | |||||||||||||||||||||||||
| Limitations | Patients are eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are eligible if the medication is not covered under Medicare Patients are eligible if Medicare coverage has been exhausted | |||||||||||||||||||||||||
| Appeals | ||||||||||||||||||||||||||
| Conditions | Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied | |||||||||||||||||||||||||
| Other Medications | ||||||||||||||||||||||||||
| Other Medications available in this program |
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