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RX MEDS PARTNER, LLC makes every effort to supply the most accurate and reliable information. However it does not guarantee
or warrant that the information on this web site is up-to-date.
We update changes to program requirements and applications
on a weekly basis from the Pharmaceutical companies offering
these programs.
We
assume no responsibility for the use or application of
any posted material. This web site is intended solely
for the purpose of electronically providing our members
with patient assistance program information and convenient
access to the online information. We assume no responsibility
for any error, omissions or other discrepancies between
the electronic and printed versions of documents.
If you are seeking specific advice or counseling, you
should contact a licensed medical practitioner or professional,
a social services agency representative, or an organization
in your local community.
We
link to web sites maintained by other entities. Reasonable
precautions are taken to link only to web sites which
are appropriate, accurate and maintained by reputable
organizations. However, those web pages are not under
our control and we are not responsible for any information
or opinions expressed in those linked sites.
We do not guarantee your approval for patient assistance
programs. Each drug manufacturer company determines the
eligibility criteria for its patient assistance program
(eligibility criteria and the application process vary).
The general eligibility criteria include income requirements,
household size and status of prescription insurance coverage.
You must truthfully answer these important questions
to be sure you are eligible based on the most current
requirements.
If you have insurance such as Medicare, Medicaid
or private coverage you may qualify for discount generics.
Most Patient Assistance Programs accept patients if their income is 200% of the federal poverty
guidelines. Some accept patients with higher incomes
so you should check your eligibility through the RX Meds
Partner eligibility form. 2008
Federal poverty level guidelines are listed in the chart
below.
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2008
FPL Poverty Guidelines
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Persons
in Family or Household
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48 Contiguous
States and D.C.
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Alaska
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Hawaii
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Free
Brand name program income at 200%
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Co-Pay
Generic Rx Maximum 300%
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1
|
$10,400
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$13,000
|
$11,960
|
$20,800
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$26,000
|
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2
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$14,000
|
$17,500
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$16,100
|
$28,000
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$35,000
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3
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$17,600
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$22,000
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$20,240
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$35,200
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$44,000
|
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4
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$21,200
|
$26,500
|
$24,380
|
$42,400
|
$53,000
|
|
5
|
$24,800
|
$31,000
|
$28,520
|
$49,600
|
$62,000
|
|
6
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$28,400
|
$35,500
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$32,660
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$56,800
|
$71,000
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|
7
|
$32,000
|
$40,000
|
$36,800
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$64,000
|
$80,000
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8
|
$35,600
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$44,500
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$40,960
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$71,200
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$89,000
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THIS IS NOT INSURANCE Please read the statement below
I
have completely filled out and am submitting the Membership
Eligibility Form and would like to enroll in Rx
MEDS PARTNER, LLC.
I
understand:
- that not all medications I am taking may be available
through the pharmaceutical companies’ free brand or
discount generic drug programs.
- that the pharmaceutical companies can change their list
of medications at any time and RX Meds Partner will
accurately update their database weekly with all known
changes
- that pharmaceutical companies have certain criteria
that must be met and that the pharmaceutical companies
will make the final decision as to who qualifies for
their programs.
Below
are GENERAL GUIDELINES established for the pharmaceutical
companies Patient Assistance Programs:
1)
My gross annual family income is an eligibility requirement.
Total Gross Taxable Income includes: wages, social security,
pension, disability, interest earnings, etc. Excessive
liquid assets may disqualify you from being approved for
one or more medications. This includes savings accounts,
cd and money market accounts. It does not include my primary
home, car or other possessions.
2)
I currently have no coverage (insurance or government
program) that reimburses or pays for my prescription medications
and I am experiencing a hardship in purchasing them.
3)
I will be required to provide proof of my income to be
sent with my applications or if I have zero income I will
attach a Self Declaration of Income letter signed
by my doctor or a social worker. Here
is a form letter you can use:
Click
Here for Declaration of Income
(You will need a doctor or social worker to sign this
form.)
4)
Each pharmaceutical company determines whether my medication
is shipped to my physician, picked up at a local pharmacy,
or shipped directly to my home. Neither Rx MEDS PARTNER, LLC
nor I can decide where medications are to be delivered.
I will contact my physician to be sure his office will
participate with me in these programs.
5)
Rx MEDS PARTNER, LLC
acts a web-based research assistant to supply all applications
and other forms necessary to receive Free Brand or discount
generic drugs offered by pharmaceutical companies; Rx
MEDS PARTNER, LLC does not manufacture drugs,
prescribe drugs, dispense drugs, recommend medication,
or evaluate prescriptions. Rx
MEDS PARTNER, LLC will
notify me of the refill requirements for all my medications
and continue service available to me for any new medications
or changes in medications during my paid membership period.
6) I may cancel
my membership at any time, but no refund will be issued
as benefits are paid on a monthly basis and no partial
month fees will be refunded.
I
attest that the information provided in my eligibility
form is complete and accurate. By my submission of this
form, I authorize Rx MEDS PARTNER, LLC to use the information
to pre-qualify me for Patient Assistance Programs. I understand
that any such information provided by me in this form,
will be used by Rx
MEDS PARTNER, LLC solely to administer PAP
program and those services provided only by Rx MEDS PARTNER, LLC,
but will not be used or disclosed for any other purposes,
except as may be required by applicable law.
I
understand that Rx MEDS PARTNER, LLC
will not be held responsible in the event I provide information
deemed to be fraudulent.
A
refund of membership fees will be available if I am
disqualified for any program I apply to using the
same information I provided in my eligibility form.
To apply for a refund I must send the following documents
to Rx MEDS PARTNER, LLC:
1)
a denial letter and 2) a copy of my application form and
documents I used to apply for a program within 60 days
of applying for a program. If the information supplied
to RX Meds Partner on my eligibility form is not
the same as on my program application a refund
will be denied. If my doctor refuses to participate a
refund will be denied.
Mail
refund requests to:
Rx
Meds Partner
54 North Lake Circle
Manning, SC 29102
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