Patient Assistance Programs |
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| Patient Assistance Program (PAP) information is provided to assist Medical Case Managers and Ryan White Program clients in accessing medications available through PAPs. Below are Eligibility Guidelines - to access a specific drug through its PAP - and Enrollment/Application Forms - which is a direct link to the PAP website or enrollment form, if applicable. We suggest you first check the eligibility guidelines and then, if the requirements appear to be met, click on the right-hand column for the PAP enrollment/application form. | |
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| Eligibility Guidelines | Enrollment/Application Forms |
| ABILIFY (aripiprazole) | ABILIFY (aripiprazole) |
| ALDARA (imiquimod) No PAP | |
| APTIVUS (tipranavir) | APTIVUS (tipranavir) |
| APTIVUS (tipranavir) For Medicare | APTIVUS (tipranavir) For Medicare |
| ATRIPLA (tenofovir/emtricitabine/efavire) | ATRIPLA (tenofovir/emtricitabine/efavire) |
| ATRIPLA (tenofovir/emtricitabine/efavire) Co-Pay | |
| ATRIPLA (tenofovir/emtricitabine/efavire) Welvista | ATRIPLA (tenofovir/emtricitabine/efavire) Welvista |
| BACTRIM DS (tmp/smz ds) Publix (14 days Free) | |
| BACTRIM DS (tmp/smz ds) Rx Outreach (180 days/$20) | BACTRIM DS (tmp/smz ds) Rx Outreach (180 days/$20) |
| BACTROBAN (mupirocin) | BACTROBAN (mupirocin) |
| BARACLUDE (entecavir) | BARACLUDE (entecavir) |
| BIAXIN (clarithromycin) | |
| COMBIVIR (zidovudine/lamivudine) | COMBIVIR (zidovudine/lamivudine) |
| COMBIVIR (zidovudine/lamivudine) Savings Card | COMBIVIR (zidovudine/lamivudine) Savings Card |
| COMPAZINE (prochlorperazine) Low Cost Retail | |
| COMPLERA (rilpivirine /tenofovir/ emtricitabine) | COMPLERA (rilpivirine /tenofovir/ emtricitabine) |
| CRESTOR (rosuvastatin) | CRESTOR (rosuvastatin) |
| CRESTOR (rosuvastatin) For Medicare Part D | CRESTOR (rosuvastatin) For Medicare Part D |
| CRIXIVAN (indinavir) | CRIXIVAN (indinavir) |
| CRIXIVAN (indinavir) Welvista | CRIXIVAN (indinavir) Welvista |
| CYMBALTA (duloxetine) | CYMBALTA (duloxetine) |
| Eligibility Guidelines | Enrollment/Application Forms |
| DAPSONE (diamino-diphenyl sulfone) No PAP | |
| DARAPRIM (pyrimethamine) | DARAPRIM (pyrimethamine) |
| DEPAKOTE (divalproex sodium) | DEPAKOTE (divalproex sodium) |
| DIABETA (glyburide) Low Cost Retail | |
| DIFLUCAN (fluconazole) Pfizer Connection to Care | DIFLUCAN (fluconazole) Pfizer Connection to Care |
| DIFLUCAN (fluconazole) Pfizer Pfriends | DIFLUCAN (fluconazole) Pfizer Pfriends |
| DROXIA (hydroxia) | DROXIA (hydroxia) |
| EDURANT (rilpivirine) | EDURANT (rilpivirine) |
| EDURANT (rilpivirine) Welvista | EDURANT (rilpivirine) Welvista |
| ELAVIL (amitriptyline) Low Cost Retail | |
| EMTRIVA (emtricitabine) | EMTRIVA (emtricitabine) |
| EMTRIVA (emtricitabine) Welvista | EMTRIVA (emtricitabine) Welvista |
| EPIVIR (lamivudine) | EPIVIR (lamivudine) |
| EPIVIR (lamivudine) Savings Card | EPIVIR (lamivudine) Savings Card |
| EPIVIR HBV (lamivudine) | EPIVIR HBV (lamivudine) |
| EPOGEN (epoetin alpha) | EPOGEN (epoetin alpha) |
| EPZICOM (abicavir/lamivudine) | EPZICOM (abicavir/lamivudine) |
| EPZICOM (abicavir/lamivudine) Savings Card | EPZICOM (abicavir/lamivudine) Savings Card |
| FLUMADINE (rimantadine) No PAP | |
| FOLINIC ACID (leucovorin) No PAP | |
| FUZEON (enfuvirtide) | |
| Eligibility Guidelines | Enrollment/Application Forms |
| GEODON (ziprasidone hcl) | GEODON (ziprasidone hcl) |
| GLUCOPHAGE (metformin) Low Cost Retail | |
| GLUCOTROL (glipizide) | GLUCOTROL (glipizide) |
| GLUCOTROL (glipizide) Low Cost Retail | |
| HEPSERA (adefovir) | HEPSERA (adefovir) |
| HYDREA (hydroxyurea) | HYDREA (hydroxyurea) |
| INTELENCE (etravirine) | INTELENCE (etravirine) |
| INTELENCE (etravirine) Welvista | INTELENCE (etravirine) Welvista |
| INVIRASE (saquinavir) | |
| ISENTRESS (raltegravir) | ISENTRESS (raltegravir) |
| ISENTRESS (raltegravir) Co-Pay | ISENTRESS (raltegravir) Co-Pay |
| ISENTRESS (raltegravir) Welvista | ISENTRESS (raltegravir) Welvista |
| KALETRA (lopinavir) | KALETRA (lopinavir) |
| KALETRA (lopinavir) Welvista | KALETRA (lopinavir) Welvista |
| KEPPRA (levetiracetam) No PAP | |
| Eligibility Guidelines | Enrollment/Application Forms |
| LAMICTAL (lamotrigine) | LAMICTAL (lamotrigine) |
| LEVAQUIN (levofloxacin) | LEVAQUIN (levofloxacin) |
| LEXAPRO (escitalopram oxalate) | LEXAPRO (escitalopram oxalate) |
| LEXIVA (fosamprenavir) | LEXIVA (fosamprenavir) |
| LEXIVA (fosamprenavir) Savings Card | LEXIVA (fosamprenavir) Savings Card |
| LIPITOR (atorvastatin) | LIPITOR (atorvastatin) |
| LOMOTIL (diphenoxylate) | LOMOTIL (diphenoxylate) |
| LOPID (gemfibrozil) | LOPID (gemfibrozil) |
| LOPID (gemfibrozil) Savings Card | LOPID (gemfibrozil) Savings Card |
| LYRICA (pregabalin) | LYRICA (pregabalin) |
| MARAVIROC (selzentry) | MARAVIROC (selzentry) |
| MARAVIROC (selzentry) Savings Card | MARAVIROC (selzentry) Savings Card |
| MARINOL (dronabinol) No PAP | |
| MEGACE (megestrol) Low Cost Retail | |
| MEPRON (atovaquone) | MEPRON (atovaquone) |
| MONISTAT (miconazole) | MONISTAT (miconazole) |
| MYAMBUTOL (ethambutol) No PAP | |
| MYCELEX TROCHE (clotrimazole) | MYCELEX TROCHE (clotrimazole) |
| MYCOBUTIN (rifabutin) Pfizer Connection to Care | MYCOBUTIN (rifabutin) Pfizer Connection to Care |
| MYCOBUTIN (rifabutin) Pfizer Pfriends | MYCOBUTIN (rifabutin) Pfizer Pfriends |
| Eligibility Guidelines | Enrollment/Application Forms |
| NEUPOGEN (filgrastim) | NEUPOGEN (filgrastim) |
| NEURONTIN (gabapentin) | NEURONTIN (gabapentin) |
| NIZORAL (ketoconazole) | NIZORAL (ketoconazole) |
| NORVIR (ritonavir) | NORVIR (ritonavir) |
| NORVIR (ritonavir) Welvista | NORVIR (ritonavir) Welvista |
| OXANDRIN (oxandrolone) No PAP | |
| PAMELOR (nortriptyline) | PAMELOR (nortriptyline) |
| PEGASYS (peginterferon alfa)(2a) | |
| PEG-INTRON (peginterferon alfa)(2b) | PEG-INTRON (peginterferon alfa)(2b) |
| PRAVACHOL (pravastatin) | PRAVACHOL (pravastatin) |
| PREZISTA (darunavir) | PREZISTA (darunavir) |
| PREZISTA (darunavir) Welvista | PREZISTA (darunavir) Welvista |
| PRILOSEC (omeprazole) | PRILOSEC (omeprazole) |
| PROCRIT (epoetin alfa) | PROCRIT (epoetin alfa) |
| PROZAC (fluoxetine) | PROZAC (fluoxetine) |
| Eligibility Guidelines | Enrollment/Application Forms |
| RELENZA (zanamivir) | RELENZA (zanamivir) |
| REMERON (mirtazapine) | REMERON (mirtazapine) |
| RESCRIPTOR (delavirdine) | RESCRIPTOR (delavirdine) |
| RESCRIPTOR (delavirdine) Savings Card | RESCRIPTOR (delavirdine) Savings Card |
| RETROVIR (zidovudine) | RETROVIR (zidovudine) |
| RETROVIR (zidovudine) Savings Card | RETROVIR (zidovudine) Savings Card |
| REYATAZ (atazanavir) | REYATAZ (atazanavir) |
| REYATAZ (atazanavir) Savings Card | REYATAZ (atazanavir) Savings Card |
| REYATAZ (atazanavir) Co-Pay (Bristol-Meyers) | REYATAZ (atazanavir) Co-Pay (Bristol-Meyers) |
| REYATAZ (atazanavir) Co-Pay (Xubex) | REYATAZ (atazanavir) Co-Pay (Xubex) |
| RIBASPHERE (ribavirin) No PAP | |
| RISPERDAL (risperidone) | RISPERDAL (risperidone) |
| SPORANOX (itraconazole) | SPORANOX (itraconazole) |
| SULFADIAZINE (sulfadiazine) No PAP | |
| SUSTIVA (efavirenz) | SUSTIVA (efavirenz) |
| SUSTIVA (efavirenz) Savings Card | SUSTIVA (efavirenz) Savings Card |
| SUSTIVA (efavirenz) Co-Pay (Bristol-Meyers) | SUSTIVA (efavirenz) Co-Pay (Bristol-Meyers) |
| SUSTIVA (efavirenz) Co-Pay (Xubex) | SUSTIVA (efavirenz) Co-Pay (Xubex) |
| SYMMETREL (amantadine) No PAP | |
| Eligibility Guidelines | Enrollment/Application Forms |
| TAMIFLU (oseltamivir) No PAP | |
| TERAZOL (terconazole) | TERAZOL (terconazole) |
| TESTOSTERONE - ANDROGEL (testosterone gel) | TESTOSTERONE - ANDROGEL (testosterone gel) |
| TESTOSTERONE - DEPO-TESTOSTERONE (injection) | No PAP |
| TRICOR (Fenofibrate) | TRICOR (Fenofibrate) |
| TRIZIVIR (abicavir/lamivudine/zidovudine) | TRIZIVIR (abicavir/lamivudine/zidovudine) |
| TRIZIVIR (abicavir/lamivudine/zidovudine) Savings Card | TRIZIVIR (abicavir/lamivudine/zidovudine) Savings Card |
| TRUVADA (tenofovir/emtricitabine) | TRUVADA (tenofovir/emtricitabine) |
| TRUVADA (tenofovir/emtricitabine) Co-Pay | TRUVADA (tenofovir/emtricitabine) Co-Pay |
| TRUVADA (tenofovir/emtricitabine) Welvista | TRUVADA (tenofovir/emtricitabine) Welvista |
| VALCYTE (valganciclovir hcl) | |
| VALTREX (valacyclovir hcl) | VALTREX (Valacyclovir HCL) |
| VIDEX (didanosine) | |
| VIRACEPT (nelfinavir) | VIRACEPT (nelfinavir) |
| VIRACEPT (nelfinavir) Savings Card | VIRACEPT (nelfinavir) Savings Card |
| VIRAMUNE (nevirapine) | VIRAMUNE (nevirapine) |
| VIRAMUNE (nevirapine) For Medicare | VIRAMUNE (nevirapine) For Medicare |
| VIREAD (tenofovir) | VIREAD (tenofovir) |
| VIREAD (tenofovir) Welvista | VIREAD (tenofovir) Welvista |
| WELLBUTRIN (bupropion) Low Cost Retail | |
| ZERIT (stavudine) | |
| ZIAGEN (abacavir) | ZIAGEN(abacavir) |
| ZIAGEN (abacavir) Savings Card | ZIAGEN (abacavir) Savings Card |
| ZITHROMAX (azithromycin) Pfizer Connection to Care | ZITHROMAX (azithromycin) Pfizer Connection to Care |
| ZITHROMAX (azithromycin) Pfizer Pfriends | ZITHROMAX (azithromycin) Pfizer Pfriends |
| ZOLOFT (sertraline) | ZOLOFT (sertraline) |
| ZOVIRAX (acyclovir) | ZOVIRAX(acyclovir) |
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Information is current as of posting date; please notify Susy Martinez of corrections or updates.
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