rxhelp360.org
| 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 |
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