Thank you for your interest in the

     

Be a resident of the United States, Puerto Rico, or the Virgin Islands
Not be eligible for any prescription drug benefits through any private or public insurer/payer/program
Have a total family income of 200% or below the federal poverty level for your patient’s state
Have a prescription for one or more of the Teva medicines listed on page 2 of the enclosed application

To enroll:

Click here to download a copy of the two-page application with instructions to complete.
     Patients will be notified by mail of program acceptance or denial
If patient is approved for assistance, you will receive a form to complete and return. The patient’s medicine(s) will be shipped to your office
     directly from the Teva pharmacy
Once the patient is approved for the program, he or she will be eligible to receive assistance for up to 6 months. Renewals will be handled on
     a per-patient basis

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