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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

Click here to download a copy of the application with instructions to complete and return it to your healthcare professional. Patients 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:

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