Thank you for your interest in the
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 annual 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 it to your healthcare professional. Patient’s 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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