Drug:

 
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, opt 2
Fax 866-990-0545
Website http://www.kingpharm.com/Products/index.cfm
 
Program Requirements
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
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
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
Levoxyl 25mg - (Generic: Levothyroxine Tablet 25mcg)
Skelaxin 800mg - (Generic: )
Levoxyl 50mcg - (Generic: Levothyroxine Tablet 50mcg)
Levoxyl 75mcg - (Generic: Levothyroxine Tablet 75mcg)
Levoxyl 88mcg - (Generic: Levothyroxine Tablet 88mcg)
Levoxyl 100mcg - (Generic: Levothyroxine Tablet 100mcg)
Levoxyl 112mcg - (Generic: Levothyroxine Tablet 112mcg)
Levoxyl 125mcg - (Generic: Levothyroxine Tablet 125mcg)
Levoxyl 137mcg - (Generic: Levothyroxine Tablet 137mcg)
Levoxyl 150mcg - (Generic: Levothyroxine Tablet 150mcg)
Levoxyl 175mcg - (Generic: Levothyroxine Tablet 175mcg)
Levoxyl 200mcg - (Generic: Levothyroxine Tablet 200mcg)