rxhelp360.org
| Drug Information | ||||||||||||||||
| Drug | Rebetol | |||||||||||||||
| Generic Equivalent | ribavirin | |||||||||||||||
| Topic | Antiviral | |||||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||||
| Program | Commitment to Care | |||||||||||||||
| Company | ScheringCorp | |||||||||||||||
| Form | Download PDF | |||||||||||||||
| Program Requirements | ||||||||||||||||
| Details | Insurance card NOT required Drivers license required Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero income required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements NOT 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 NOT required as proof of income | |||||||||||||||
| Delivery of Medication | ||||||||||||||||
| Ship Time | 48 hours | |||||||||||||||
| Delivery Options | Can NOT be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card | |||||||||||||||
| Application Process | ||||||||||||||||
| 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 NOT 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 NOT apply for refills via phone Can apply for refills via fax Can 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 NOT Re-Apply via fax Can NOT Re-Apply via mail | |||||||||||||||
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals on a case by case basis Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can NOT apply for an appeal via phone Can apply via fax Can NOT apply for an appeal via mail | |||||||||||||||
| Eligibility | ||||||||||||||||
| Limitations | Patients may be eligible if LIS is denied on a case by case basis Patients are eligible with existing prescription coverage 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 may be eligible if they are accepting Medicare on a case by case basis Patients may be eligible if they are accepting Medicare part D on a case by case basis Patients may be eligible if the medication is not covered under Medicare on a case by case basis Patients may be eligible if Medicare coverage has been exhausted on a case by case basis | |||||||||||||||
| Appeals | ||||||||||||||||
| Conditions | Appeals will NOT consider out-of-pocket expenses Appeals may be consider total medical expenses on a case by case basis Appeals may be made before the patient has been denied on a case by case basis | |||||||||||||||
| Other Medications | ||||||||||||||||
| Other Medications available in this program |
| |||||||||||||||
|
|
||||||||||||||||||||
|
|
||||||||||||||||||||
