Contact info
- Phone
- 1-800-222-6885
- Fax
- 1-866-483-1305
- Mailing address
- PO Box 270Somerville, NJ 08876
Eligibility
- Patient must not have health insurance OR limited insurance coverage (including Medicare) for an AbbVie medicine and meet financial criteria based on household income and out-of-pocket medical expenses.
- Income limit, single
- 600% of the federal poverty level
- Income limit, couple
- 600% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Not published
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescription
- Prescriber license number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- 0–2 weeks
- Refills
- Physicians office must contact program for refills.
- Staying enrolled
- Not published
Medications covered
- Lupron Depot (leuprolide acetate)
- Lupron Depot (ped) (leuprolide acetate for depot supspension)