Drug: Tilade Inhaler

 
Drug Information
Drug Tilade Inhaler
 
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 required as proof of income
Letter from Doctor stating zero income required as proof of income
Form 4506T (If taxes were not filed) NOT required as proof of income
Most recent bank statements NOT 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
 
Delivery of Medication
Ship Time 4 weeks
Delivery Options Can NOT be delivered directly to the patient
Can be delivered directly to the doctor

 
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 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 NOT apply for a new application via fax
Can apply for a new application via mail
Refills Refills accepted
Patients can apply for refills
Doctors can apply for refills
Advocates can apply for refills
Can NOT apply for refills via phone
Can NOT 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 NOT Re-Apply via fax
Can 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

Hardship Appeals accepted
Patients can NOT apply for Hardship Appeals
Doctors can apply for Hardship Appeals
Advocates can NOT apply for Hardship Appeals

Can NOT apply for an appeal via phone
Can NOT apply for an appeal via fax
Can 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 NOT eligible if LIS is denied
Patients are NOT eligible with existing prescription coverage
Patients are NOT eligible if prescription is not covered
Patients are NOT eligible if prescription coverage has been exhausted
Patients are NOT eligible if they are accepting Medicare
Patients are NOT eligible if they are accepting Medicare part D
Patients are NOT eligible if the medication is not covered under Medicare
Patients are NOT eligible if Medicare coverage has been exhausted
 
Appeals
Conditions Appeals will consider out-of-pocket expenses
Appeals will consider total medical expenses
Appeals must be made after the patient has been denied
 
Other Medications
Other
 Medications
 available in
 this program
Corgard - beta-blocker Cardio (Generic: nadolol tablet)
Corzide - (Generic: )
Cytomel - (Generic: )
Intal Inhaler - (Generic: )
Intal Nebulizer Solution - (Generic: )
Levoxyl - (Generic: levothyroxine)
Skelaxin - (Generic: )
Tilade Inhaler - (Generic: )
Cytomel Tablets 5mcg - (Generic: )
Cytomel Tablets 25mcg - (Generic: )
Cytomel Tablets 50mcg - (Generic: )