rxhelp360.org
| Program Contact Info / Application Submission | ||||||||||||||||||
| Program | Purdue Frederick Patient Assistance Program (Oxy) | |||||||||||||||||
| Company | Purdue | |||||||||||||||||
| Form | Download PDF | |||||||||||||||||
| Address | c/o Express Scripts SDS, PO Box 66547, St Louis, MO 63166-6547 | |||||||||||||||||
| Phone | 800-599-6070 | |||||||||||||||||
| Website | http://www.purduepharma.com/Pages/default.aspx | |||||||||||||||||
| Program Requirements | ||||||||||||||||||
| Details | Drivers license NOT required | |||||||||||||||||
| Other Requirements | Copy of SS card and Drivers License | |||||||||||||||||
| Delivery of Medication | ||||||||||||||||||
| Ship Time | 10 business days | |||||||||||||||||
| Delivery Options | Can be delivered directly to the patient | |||||||||||||||||
| Application Process | ||||||||||||||||||
| New Applications | Can apply for a new application via fax | |||||||||||||||||
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals NOT accepted 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 eligible if LIS is denied Patients may be eligible if they are accepting Medicare on a case by case basis 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 NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied | |||||||||||||||||
| Other Medications | ||||||||||||||||||
| Other Medications available in this program |
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