DISCLAIMER:

The Program is NOT insurance; it is a “free goods” program, providing free Product only to qualifying enrollees.

The Program is intended to provide medication access for eligible patients who meet all specified criteria. Eligibility determination is made by Rx Outreach and Prasco, and participation in the Program is not guaranteed. All information provided on this webpage and attached documents are subject to change without notice. Rx Outreach and Prasco reserve the right to modify or terminate the Program at any time without prior notice. Patients are responsible for understanding the terms of their participation and for following all instructions provided by their healthcare providers. This Program does not replace medical advice from a qualified healthcare professional. Always consult your healthcare provider for medical guidance specific to your health condition and medication use. For questions or assistance, please contact Prasco@RxOutreach.org or call 1-866-578-2444.

PROGRAM TERMS AND CONDITIONS

The Program provides eligible uninsured patients with free Product from the date of enrollment in the Program through December 31, 2025, or the calendar year thereafter. Program eligibility is determined on a case-by-case basis, and patients must meet all of the following eligibility criteria to be considered for the Program:

• Patient must live in the United States, District of Columbia, or Puerto Rico.
• Patient’s household income must be at or below 300% of the Federal Poverty Level for the location of patient’s residence.
• Patient cannot have any prescription drug coverage (including Medicare Part D, Medicaid, TRICARE or commercial insurance) for the Product.
• Patient must not be enrolled in an "Alternate Funding Program," which, for the purposes of this Program, is defined as a program under the patient’s insurance which requires the patient to apply for a manufacturer patient assistance program and be denied enrollment before the patient's insurance will cover the Product.
• Patient must provide permission to validate your household income through a third-party credit reporting service, such as Experian, and if we are unable to validate your household income through such service, you must provide proof of household income or lack thereof.
• Patient must not be eligible for Puerto Rico’s Government Health Plan Mi Salud or have applied to the foregoing and been denied.
• Patient must be human and have a valid prescription for the Product from a licensed U.S. healthcare professional.
• Patient must be four (4) years of age or older. For patients under the age of 18, a parent or legal guardian must complete the application process as the applicant on behalf of the patient. The parent or legal guardian will need to provide their name and date of birth to the Rx Outreach team during the enrollment process. 
• Patient and patient’s prescriber may not bill, charge, seek credit for or otherwise submit any claim for reimbursement to any third-party payer for product provided through the Program.
• Patient must inform health insurance plan, including any Medicare Part D plan in which patient is enrolled, that patient has received the Product free of charge via the Program and could continue to receive this free supply for the remainder of the calendar year, so long as the plan does not provide coverage for the Product and patient continues to satisfy the eligibility requirements.
• No Product provided through the Program may be sold, traded, or returned for credit.
• The patient’s prescriber must not be on the List of Excluded Individuals and Entities maintained by the Office of Inspector General, U.S. Department of Health and Human Services, or participating in federally funded health care programs.
• If patient has a change in insurance status or income that would jeopardize your status as an eligible patient, you must notify the Program immediately, and you may be deemed no longer eligible for the Program.
• The Program benefits, rules, and Product availability are subject to change at any time without prior notification. Prasco reserves the right to make eligibility determinations, to set Program parameters, to monitor participation, and to change, modify, or discontinue the Program at any time without notice.

A complete Program application that is signed by the applicant is required for consideration for Program eligibility and enrollment. In addition, a valid prescription from a licensed U.S. healthcare professional is also required.

Approved patients will receive Product free of charge from the date of enrollment to the end of the calendar year, after which time patient must re-apply for continued assistance.

If enrolled in the Program, the Product will be shipped to the patient free of charge, so long as the patient has a legally valid prescription for the Product and remains eligible for the Program.

If you have any questions regarding the Program, eligibility criteria, or discontinuing participation, please contact Prasco@RxOutreach.org or call 1-866-578-2444.

How do I report product complaints or adverse events (side effects)?
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In addition, you may call 1-866-578-2444 to report a product complaint or side effect with the Rx Outreach Program Team.