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To qualify for assistance from this program, patients must:
  • 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 application with instructions to complete and return to your healthcare professional.
        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
If you have any questions, call the Teva Assistance Program toll-free number:

1-877-254-1039

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©2010 Teva Respiratory, LLC. This site is intended for U.S. healthcare professionals only.