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| Drug Information | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Drug | Tricor 145 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generic Equivalent | fenofibrate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Topic | Cholesterol | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | 866-898-1473 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 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 required as proof of income | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Requirements | Medicaid Denial Letter | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delivery of Medication | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ship Time | 5-7 business days | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delivery Options | Can 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 apply for refills Doctors can NOT apply for refills Advocates can apply for refills Can NOT apply for refills via phone Can NOT 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 NOT Re-Apply via fax Can NOT Re-Apply via mail | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Appeals | Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals 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 apply for an appeal via phone Can NOT apply for an appeal via fax Can NOT 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 NOT 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 NOT 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 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 NOT 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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