| Pharmaceutical Company | Boehringer Ingelheim |
| Program Address | Boehringer Ingelheim Patient Assistance Program PO Box 66555 St. Louis MO 63166 |
| Toll Free Phone Number | 800-556-8317 |
| Alternate Phone Number | 203-798-4131 |
| Fax Number | n/a |
| Guidelines and Notes | Income guidelines for this program are very LOW and STRINGENT. A physician can only have THREE patients enrolled in program, only one product per patient. Income limits for their program are a little over the Federal Poverty Guidelines, making this a program with fairly stringent eligibility guidelines. Patient must be US citizen and resident, have no complete or partial prescription insurance coverage, and income must be at or below their guidelines. |
| Initiating Enrollment | They will fax form upon request. |
| Health Provider's Role | Doctor completes, signs, ATTACHES PRESCRIPTION and sends. |
| Patient's Role | Detailed financial and insurance information needed. |
| How Dispensed | Sends medicine to doctor's office in 2-3 weeks. |
| Amount Dispensed | Up to 3 month supply at a time. Thirty days for controlled substances. |
| Refills | New application (with proof of income) only needed annually.. |
| Limit | Indefinitely. |