Eligibility requirements
- An annual household income of less than $16,000 for individuals and $25,000 for families
- No prescription insurance (including Medicaid, Medicare, or any private assistance program)
- A completed and signed (by both patient and healthcare provider) application form
- An original, signed prescription
- A copy of the patient's tax return for the previous year, or completed IRS Tax Form 4506 (see instructions on application)
- All other supporting documentation on income
- All required documents should be sent to Meda Pharmaceuticals, Patient Assistance Program, 265 Davidson Avenue, Suite 300, Somerset, NJ 08873-4120
- One 90-day supply of medication will be mailed directly to the healthcare provider
- A separate application form and prescription are required each 90-day supply of medication
- Income documentation is required only once a year
