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Rx OUTREACH (RXOUTREACH) | RxAssist
Contact info Mailing address RxOutreach PO Box 66536 St. Louis, MO 63166-6536 Eligibility An individual of any age can participate in the program, as long as the program's financial guidelines are met.
Contact program for enrollment or enroll online at www.rxoutreach.org.
Income limit, single Not published
Income limit, couple Not published
Dependents Income limit goes up for each dependent Medical expenses can be deducted Social Security number asked for US citizenship or residency required Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab) .
Application process Documents to attach Prescription Also include check, money order or credit card information.
Prescriber license number Not required
Who can sign Only patient needs to sign the application. Application can be faxed
Decision letter sent to No letter is sent Getting the medication
Patient receives Medication
Shipped to Provider. medications sent to wherever the patient requests it.
Supply per shipment 90-day supply
Some medications have 180-day supplies available.
Time to first delivery 0–2 weeks
Refills Prescription can be written with refills for up to one year. Staying enrolled New application every 12 months More from the program A separate application must be submitted for each household member applying for medication. Only one application is required per patient; however, a doctor's prescription for each medication must accompany the application.
Administrative fees for medications vary. Please refer to the application for the appropriate fees. Medications covered Abilify (aripiprazole) Allegra OTC (fexofenadine OTC tablet) Ampyra Tablet (dalfampridine) Aygestin (norethindrone acetate tablet) Baraclude (entecavir) Celebrex (celecoxib) Colazal (balsalazide) Cytra-K (potassium citrate) Effexor XR (venlafaxine) Epinephrine auto injector .15mg (epinephrine auto injector) Application forms & instructions This program doesn't publish a form. Call or visit the program website to apply.
EpiPen
(epinephrine)
EpiPen Jr (epinephrine)
Famvir (famciclovir tablet)
Flexeril (Cyclobenzaprine)
Klor-Con 8mEQ (potassium chloride ER tablet)
Klor-Con M10 (potassium chloride ER tablet)
Nardil (phenelzine sulfate)
Symmetrel (amantadine)
Tegretol XR (carbamazepine extended release)
Zonegran (zonisamide)
Accolate (zafirlukast) generic
Accupril (quinapril HCI) generic
Accuretic (quinapril/HCTZ tablet) generic
Aciphex (rabeprazole sodium) generic
Aclovate (alclometasone dipropionate cream) generic
Actonel (risedronate sodium tablet) generic
Actos (pioglitazone hydrochloride) generic
Adalat cc (nifedipine CR tablet) generic
Adderall XR (dextroamphetamine-amphetamine ER capsule) generic
Alaway OTC (ketotifen fumerate OTC solution) generic
Albuterol Inhalation Solution (albuterol inhalation solution) generic
Aldactazide (spironolactone and hydrochlorothiazide) generic
Aldactone (spironolactone) generic
Altace (ramipril) generic
Amaryl (glimepiride) generic
Ambien (Zolpidem) generic
Amoxapine tablet (amoxapine tablet) generic
Anafranil (clomipramine hcl) generic
Anaprox DS (naproxen sodium tablet) generic
AndroGel (testosterone gel) generic
Antivert (meclizine HCI) generic
Aricept (donepezil HCI) generic
Arimidex (anastrazole) generic
Artificial Tears 1.4% drops (OTC) (artificial tears 1.4% drops (OTC)) generic
Aspirin EC Tablet (OTC) (aspirin EC tablet (OTC)) generic
Astelin (Azelastine nasal spray) generic
Astepro (azelastine) generic
Atacand (candesartan cilextil) generic
Atacand HCT (candesartan cilexetil-hydrochlorothiazide) generic
Ativan (lorazepam tablet) generic
Avalide (irbesartan-hydrochlorothiazide) generic
Avapro (irbesartan) generic
Azilect (rasagiline tablets) generic
Azulfidine (sulfasalazine) generic
Azulfidine EN-Tabs (sulfasalazine, USP) generic
Bactrim DS (sulfamethoxazole/trimethoprim DS tablet) generic
Banzel (rufinamide) generic
Banzel Oral Suspension 40mg/ml (rufinamide) generic
Bentyl (dicyclomine capsule) generic
Bentyl (dicyclomine tablet) generic
Benzonatate capsule (benzonatate capsule) generic
Benztropine tablet (benztropine tablet) generic
Brimonidine Tartrate 0.2% Solution (brimonidine tartrate) generic
Bromocriptine tablet (bromocriptine tablet) generic
Buspar (buspirone tablet) generic
Calan (verapamil HCl) generic
Calan-SR (verapamil SR tablet) generic
Capoten (captopril tablet) generic
Capsaicin Cream, 0.035% (OTC) (capsaicin cream, 0.035% (OTC)) generic
Carafate (sucralfate) generic
Cardizem CD (diltiazem hcl cd) generic
Cardura (doxazosin mesylate) generic
Casodex (bicalutamide) generic
Catapres (clonidine HCL tablets) generic
Catapres TTS -3 (clonidine patch) generic
Celexa (citalopram tablet) generic
CellCept (mycophenolate mofetil) generic
Chlordiazepoxide capsule (chlordiazepoxide capsule) generic
Chlorpromazine HCL (chlorpromazine HCL) generic
Chlorthalidone tablet (chlorthalidone tablet) generic
Claritin OTC (loratadine OTC tablet) generic
Cleocin (clindamycin phosphate) generic
Colestid (colestipol hcl) generic
Cordarone (amiodarone tablet) generic
Coreg tablets (carvedilol) generic
Cozaar (losartan potassium) generic
Crestor (rosuvastatin calcium) generic
Cytomel (liothyronine sodium) generic
Dacogen (decitabine) generic
Depakene (valproic acid) generic
Depakote (Divalproex DR tablet) generic
Depo-Testosterone (testosterone cypionate) generic
Desyrel (trazodone tablet) generic
Detrol (tolterodine tartrate tablet) generic
Dextroamphetamine sulfate ER capsule (dextroamphetamine sulfate ER capsule) generic
Dextroamphetamine-Amphetamine tablet (dextroamphetamine-amphetamine tablet) generic
Dibenzyline capsule (phenoxybenzamine) generic
Diflucan (fluconazole) generic
Dilacor XR (diltiazem ER capsule) generic
Dilantin (phenytoin sodium capsule) generic
Diovan (valsartan hydrochloride) generic
Diovan HCT (valsartan hydrochlorothiazide) generic
Diprolene Cream (augmented betamethasone dipropionate) generic
Ditropan (oxybutynin tablet) generic
Donnatal Elixir (Phenobarbital, Hyoscyamine Sulfate, Atropine Sulfate, Scopolamine Hydrobromide) generic
Donnatal Tablet (Belladonna Alkaloids with Phenobarbital) generic
Doxepin capsule (doxepin capsule) generic
DuoNeb (Ipratropium/Albuterol Inhalation Solution) generic
Dutoprol Tablet (metoprolol succinate/hctz) generic
Dyazide (triamterene/HCTZ capsule) generic
Dynacin (minocycline HCL capsule) generic
Dyrenium capsule (triamterene) generic
Effexor (venlafaxine tablet) generic
Elavil (amitriptyline tablet) generic
Elocon Cream (mometasone furoate) generic
Elocon Ointment (mometasone furoate) generic
Enulose (lactulose oral solution) generic
Epinephrine Auto Injector .3mg (epinephrine auto injector) generic
Eplerenone tablet (eplerenone tablet) generic
Estrace (estradiol tablet) generic
Evista (raloxifene tablet) generic
Evoxac (cevimeline HCl) generic
Exelon (rivastigmine tartrate capsule) generic
Exforge (amlodipine and valsartan) generic
Exforge HCT (amlodipine, valsartan, hydrochlorothiazide) generic
Femara (letrozole) generic
Ferrous Sulfate EC tablet (ferrous sulfate EC tablet) generic
Flecainide Acetate tablet (flecainide acetate tablet) generic
Flomax (tamsulosin hydrochloride) generic
Flonase (50 mcg) (fluticasone nasal spray (50 mcg)) generic
Fluvoxamine Maleate tablet (fluvoxamine maleate tablet) generic
Focalin (Dexmethylphenidate HCl tablet) generic
Folic Acid (folic acid tablet) generic
Folic Acid 2.2 tablet (folic acid 2.2 tablet) generic
Fortical Nasal Spray (Calcitonin-salmon (rDNA origin)) generic
Fosamax (alendronate tablet) generic
Glucophage (metformin) generic
Glucophage XR (metformin hcl, extended release) generic
Glucotrol (glipizide) generic
Glucotrol XL (glipizide extended release) generic
Glucovance (glyburide/Metformin tablet) generic
Glynase PresTab (micronized glyburide) generic
Haloperidol tablet (haloperidol tablet) generic
Hexalen capsules (altretamine) generic
Hydralazine tablet (hydralazine tablet) generic
Hydrea (hydroxyurea capsule) generic
hydrochlorothiazide tablet (hydrochlorothiazide tablet) generic
Hydrocortisone tablet (hydrocortisone tablet) generic
Hydroxyzine HCL tablet (hydroxyzine HCL tablet) generic
Hytrin (terazosin capsule) generic
Hyzaar (antihypertensive combinations) generic
Imdur (isosorbide mononitrate) generic
Imitrex (Tablets) (sumatriptan succinate) generic
Imuran (azathioprine) generic
Indapamide tablet (indapamide tablet) generic
Inderal (propranolol tablet) generic
Inderal LA Capsules (propranolol HCL ER) generic
Intuniv Extended Release Tablets (guanfacine) generic
Ismo (isosorbide mononitrate (10mg,20mg)) generic
Isoniazid/INH (isoniazid tablet) generic
Isoptin-SR (verapamil SR tablet) generic
Jantoven (warfarin sodium) generic
K-Dur 20MEQ (potassium chloride ER tablet) generic
Keppra (levetiracetam tablet) generic
Keppra XR tablets (levetiracetam ER) generic
Klonopin (clonazepam tablet) generic
Klor-Con 10mEQ (potassium chloride ER tablet) generic
Klor-Con M20 (potassium chloride ER tablet) generic
Lamictal (lamotrigine) generic
Lanoxin (digoxin tablets) generic
Lasix (furosemide tablet) generic
Levoxyl (levothyroxine) generic
Lexapro (escitalopram oxalate) generic
Lexapro 20mg (escitalopram oxalate) generic
Lexapro 5mg (escitalopram oxalate) generic
Lidocaine 2% viscous solution (lidocaine 2% viscous solution) generic
Lidoderm (lidocaine patch 5%) generic
Lioresal (baclofen tablet) generic
Lipitor (atorvastatin calcium) generic
Lithium Carbonate (Lithium Carbonate capsule) generic
Lodine (etodolac capsule) generic
Lodine tablet (etodolac tablet) generic
Lofibra (fenofibrate, micronized capsule) generic
Lomotil (diphenoxylate hydrochloride/atropine sulfate) generic
Lonox (diphenoxylate/atropine tablet) generic
Loperamide capsule (loperamide capsule) generic
Lopid (gemfibrozil) generic
Lopressor (metoprolol tartrate tablet) generic
Lotensin (benazepril tablet) generic
Lotensin HCT (benazepril HCTZ tablet) generic
Lotrel (Amlodipine/Benazepril capsule) generic
Lotrisone Cream (clotrimazole/betamethasone cream) generic
Lovaza (omega-3-acid ethyl esters) generic
Loxapine capsule (loxapine capsule) generic
Lunesta (eszopiclone) generic
Magnesium Oxide tablet (OTC) (magnesium oxide tablet (OTC)) generic
Mavik (trandolapril tablet) generic
Maxzide (triamterene/HCTZ tablet) generic
Mestinon (pyridostigmine bromide) generic
Metadate CD (methylphenidate CD capsule) generic
Methotrexate (methotrexate) generic
Mevacor (lovastatin tablet) generic
Micardis (telmisartan) generic
Micronase (glyburide tablet) generic
Microzide (hydrochlorothiazide capsule) generic
Midodrine HCl tablet (midodrine HCl tablet) generic
Minocin (minocycline capsule) generic
Mirapex tablets (pramipexole dihydrochloride tablets) generic
Mobic (meloxicam) generic
Monoket (isosorbide mononitrate (10mg,20mg)) generic
Motrin (ibuprofen tablet) generic
Mysoline (primidone) generic
Nabumetone tablet (nabumetone tablet) generic
Namenda (memantine hcl) generic
Naprosyn (naproxen tablet) generic
Neurontin (gabapentin) generic
Nexium (esomeprazole DR capsule) generic
Niacin (niacin) generic
Niacin SA capsule (OTC) (niacin SA capsule (OTC)) generic
Niaspan ER (niacin extented-release tablets) generic
Nifedipine capsule (nifedipine capsule) generic
Nilandron tablet (nilutamide) generic
Nitroglycerin SA capsule (nitroglycerin SA capsule) generic
Norvasc (amlodipine besylate) generic
Nystatin powder (nyamyc topical powder) generic
Nystatin tablet (nystatin tablet) generic
Ogen (estropipate tablet) generic
Ortho Micronor (norethindrone tablet) generic
Ortho-Cyclen (sprintec tablet) generic
Ortho-Tri-Cyclen (tri-previfem tablet) generic
Ortho-Tri-Cyclen (tri-sprintec tablet) generic
Ovcon 35 (norethindrone/ethinyl estradiol tablet) generic
Oxandrin (oxandrolone tablet) generic
Pamelor (nortriptyline HCL capsule) generic
Panretin gel (alitretinoin) generic
Parnate 10mg tablets (tranylcypromine) generic
Paxil (paroxetine HCL tablet) generic
Pepcid (famotidine tablet) generic
Perphenazine tablet (perphenazine tablet) generic
PhosLo gelcaps (calcium acetate) generic
Plaquenil (hydroxychloroquine tablet) generic
Plavix (clopidogrel bisulfate tablets) generic
Plendil ER (felodipine ER tablet) generic
Pletal (cilostazol tablet) generic
PNV Prenatal Multivitamin Plus Iron (PNV Prenatal Multivitamin Plus Iron) generic
Potassium Iodide (SSKI oral solution) generic
Prandin (repaglinide tablet) generic
Pravachol (pravastatin tablet) generic
prazosin capsule (prazosin capsule) generic
Prednisone tablet (prednisone tablet) generic
Prevacid (lansoprazole DR capsule) generic
Prevalite Powder (cholestyramine) generic
Prilosec (omeprazole capsule) generic
Prinivil (lisinopril tablet) generic
Prinzide (lisinopril/HCTZ tablet) generic
ProAir RespiClick Powder Inhaler (albuterol sulfate) generic
Prochlorperazine tablet (prochlorperazine tablet) generic
Progesterone capsule (progesterone capsule) generic
Prograf (tacrolimus capsule) generic
Propylthiouracil tablet (propylthiouracil tablet) generic
Proscar (finasteride tablet) generic
Protonix (pantoprazole sodium) generic
Provera (medroxyprogesterone acetate) generic
Prozac (fluoxetine capsule) generic
Pulmicort Respules (budesonide inhalation suspension) generic
Qudexy XR capsule (topiramate ER) generic
Ranexa (ranolazine extended-release tablets) generic
Reglan (metoclopramide HCL tablet) generic
Remeron (mirtazapine tablet) generic
Requip tablets (ropinirole hydrochloride) generic
Restoril (temazepam) generic
Restoril (temazepam capsule) generic
Revatio (sildenafil citrate tablet) generic
Risperdal (risperidone) generic
Ritalin (methylphenidate tablet) generic
Ritalin LA (methylphenidate hcl) generic
Robaxin (methocarbamol tablet) generic
Rocaltrol (calcitriol capsule) generic
Rythmol (propafenone hydrochloride) generic
Salagen Tablet (pilocarpine) generic
Septra DS (sulfamethoxazole/trimethoprim DS tablet) generic
Seroquel (quetiapine fumarate) generic
Sinemet (carbidopa/levo tablet) generic
Sinemet CR (carbidopa/levo SR tablet) generic
Singulair (montelukast sodium) generic
Sonata (zaleplon) generic
SSKI oral solution (potassium Iodide) generic
Synthroid (levothyroxine) generic
Tamoxifen citrate tablet (tamoxifen citrate tablet) generic
Tapazole (methimazole tablets) generic
Tegretol (carbamazepine tablet) generic
Tenoretic (atenolol/chlorthalidone tablet) generic
Tenormin (atenolol tablet) generic
Tessalon Capsule (benzonatate) generic
Topamax tablets (topiramate) generic
Trandate (labetalol HCL tablet) generic
Trental (pentoxifylline ER tablet) generic
Triamcinolone cream, 0.1% (triamcinolone cream, 0.1%) generic
Triamcinolone ointment, 0.1% (triamcinolone ointment, 0.1%) generic
Tricor (fenofibrate) generic
Trifluoperazine HCl tablet (trifluoperazine HCl tablet) generic
Trilipix (fenofibric acid DR capsule) generic
Trospium Chloride tablet (trospium chloride tablet) generic
Trusopt (dorzolamide HCL) generic
Ultracet (tramadol hydrochloride/acetaminophen tablets) generic
Ultram (tramadol tablet) generic
Ultravate (halobetasol prop ointment, 0.05%) generic
Urecholine (bethanechol tablet) generic
Uroxatral (alfuzosin hcl) generic
Valium (diazepam tablet) generic
Valtrex tablet (valacyclovir HCL tablet) generic
Vaseretic (enalapril maleate-hydrochlorothiazide tablets) generic
Vasotec (enalapril maleate tablet) generic
Viagra (sildenefil citrate) generic
Vimpat (lacosamide) generic
Vistaril (hydroxyzine pamoate) generic
Vitamin B Complex capsule (OTC) (Vitamin B Complex capsule (OTC)) generic
Vitamin B-6 tablet (OTC) (Vitamin B-6 tablet (OTC)) generic
Vitamin D3 capsule (OTC) (Vitamin D3 capsule (OTC)) generic
Vitamin D3 tablet (OTC) (Vitamin D3 tablet (OTC)) generic
Vogelxo gel packet (testosterone gel packet) generic
Vogelxo gel pump (testosterone gel pump) generic
Vogelxo gel tube (testosterone gel tube) generic
Voltaren (diclofenac EC tablet) generic
Voltaren XR (diclofenac ER tablet) generic
Wellbutrin (bupropion HCL tablet) generic
Wellbutrin SR (bupropion hcl) generic
Wellbutrin XL (bupropion hcl) generic
Xalatan (latanoprost solution) generic
Xanax (alprazolam) generic
Xopenex (levalbuterol hcl) generic
Xyzal tablets (levocetirizine dihydrochloride) generic
Zanaflex (Tizanidine 4mg tab) generic
Zaroxolyn (metolazone tablet) generic
Zestoretic (lisinopril/HCTZ tablet) generic
Zestril (lisinopril tablet) generic
Ziac (bisoprolol/HCTZ tablet) generic
Zidovudine tablet (zidovudine tablet) generic
Zocor (simvastatin tablets) generic
Zofran (ondansetron tablet) generic
Zofran ODT (ondansetron ODT tablet) generic
Zoloft (sertraline HCI) generic
Zovirax (acyclovir capsule) generic
Zovirax (acyclovir tablet) generic
Zyloprim (allopurinol tablet) generic
Zyprexa (olanzapine) generic
Zyrtec OTC (cetirizine HCl tablet - OTC) generic