Contact info
- Phone
- 1-855-687-7503
- Fax
- 1-855-886-2481
- Mailing address
- D-617927, AP5 NE1 N. Waukegan Rd.North Chicago, IL 60064
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
- Yes
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
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- 28-day supply
- Time to first delivery
- Not published
- Refills
- Program will contact patient to schedule the next delivery.
- Staying enrolled
- Not published
Medications covered
- Mavyret (glecaprevir/pibrentasvir)