rxhelp360.org
| Drug Information | |
| Drug | Depakene Tablets 250mg |
| Generic Equivalent | valproic acid |
| Class | Anticonvulsant |
| Topic | Neuro/ Mental Health |
| Program Contact Info / Application Submission | |
| Program | Abbott Patient Assistance Program |
| Company | AbbottPAP |
| Form | Download PDF |
| Address | Dept. D-31C, AP52 200 Abbott Park Rd. Abbott Park, IL 60064-6214 |
| Phone | 800-222-6885 |
| Fax | 908-947-0424 |
| Website | www.abbott.com/global/url/content/en_US/40.70:70/general_content/General_Content_00066.htm |
| Program Details | |
| Details | Upon determination of eligibility a letter will be sent to the doctor. Up to a 90-day supply will be sent to the doctor�s office. Refills must be requested by the doctor's office 3 weeks prior to the patient requiring further medication. A new application with documentation is required annually. Abbott will take zero for income without proof of income but after the first 90 day supply is sent to the patient, they require either proof of income or the patient will need to show that they have been denied assistance from Medicaid |
| Program Requirements | |
| Information | The doctor and patient must fill out respective portions of the application and attach proof of income and Medicaid denial letter (if applicable). NO separate prescription is required. |
| Details | Insurance card NOT required Drivers license NOT required Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero incomeNOT required as proof of income Form 4506T (If taxes were not filed) NOT required as proof of income Most recent bank statements required as proof of income Most recent check/check stub copy required as proof of income Letter from employer NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income NOT required as proof of income |
| Other Requirements | Medicaid Denial Letter |
| Delivery of Medication | |
| Ship Time | 5-7 business days |
| Delivery Options | Can NOT be delivered directly to the patient Can be delivered directly to the doctor |
| Application Process | |
| New Applications | New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can NOT apply for a new application via phone Can apply for a new application via fax Can apply for a new application via mail |
| Refills | Refills accepted Patients can NOT apply for refills Doctors can apply for refills Advocates can NOT apply for refills Can apply for refills via phone Can apply for refills via fax Can apply for refills via mail |
| Re-Applications | Re-Applications accepted Patients can apply for Re-Applications Doctors can apply for Re-Applications Advocates can apply for Re-Applications Can NOT Re-Apply via phone Can Re-Apply via fax Can Re-Apply via mail |
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals Advocates can apply for Hardship Appeals Can NOT apply for an appeal via phone Can apply via fax Can apply for an appeal via mail |
| Eligibility | |
| Eligibility | Must not have any private or public insurance for requested medication and have an income at or below 200% of the Federal Poverty Level. Abbott will consider Part D enrollees for eligibility on a case-by-case basis. Contact Abbott PAP for more information. |
| Limitations | Patients are eligible if LIS is denied Patients may be eligible with existing prescription coverage on a case by case basis Patients may be eligible if prescription is not covered on a case by case basis Patients may be eligible if prescription coverage has been exhausted on a case by case basis Patients are eligible if they are accepting Medicare Patients may be eligible if they are accepting Medicare part D on a case by case basis 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 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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