Patient Assistance Foundation - Pharmaceutical Products

Pharmaceutical Products

The Abbott Patient Assistance Foundation offers Abbott medicines to patients experiencing financial difficulties. Eligible patients typically have no healthcare coverage for the requested product and do not have access to alternative sources of coverage or funding. All applications are reviewed on a case-by-case basis to support the Abbott Patient Assistance Foundation’s purpose of providing products at no cost to individuals in need.

Pharmaceutical Products
Advicor® (niacin extended-release tablets/lovastatin tablets)	Advicor Enrollment Form
Azmacort® (triamcinolone acetonide)	Azmacort Enrollment Form
Cardizem® LA (diltiazem HCl) Extended Release Tablets Once-a-Day Dosage	Cardizem LA Tablets Enrollment Form
Depakote® Tablets (divalproex sodium delayed-release tablets)	Depakote Tablets Enrollment Form
Depakote® ER (divalproex sodium extended-release tablets)	Depakote ER Enrollment Form
Gengraf® Capsules (cyclosporine capsules, USP [MODIFIED])	Gengraf Capsules Enrollment Form
HUMIRA® (adalimumab)	HUMIRA Enrollment Form
Kaletra® (lopinavir/ritonavir) Tablets	Kaletra Tablets Enrollment Form
Kaletra® (lopinavir/ritonavir) Oral Solution	Kaletra Oral Solution Enrollment Form
LUPRON DEPOT® URO (leuprolide acetate) 7.5 mg	Lupron Depot Enrollment Form
LUPRON DEPOT® GYN (leuprolide acetate) 3.75 mg	Lupron Depot Enrollment Form
LUPRON DEPOT® GYN (leuprolide acetate) 3 Month 11.25 mg	Lupron Depot Enrollment Form
LUPRON DEPOT-PED® (leuprolide acetate) 7.5 mg, 11.25 mg and 15 mg	Lupron Depot Enrollment Form
Niaspan® Tablets (niacin extended-release tablets)	Niaspan Enrollment Form
Norvir® (ritonavir capsules) Soft Gelatin	Norvir Soft Gelatin Capsules Enrollment Form
Norvir® (ritonavir oral solution)	Norvir Oral Solution Enrollment Form
Simcor® (niacin extended-release/simvastatin)	Simcor Enrollment Form
Synthroid® (levothyroxine sodium tablets, USP)	Synthroid Enrollment Form
Tarka® (trandolapril/verapamil HCl ER tablets)	Tarka Enrollment Form
Teveten® (eprosartan mesylate)	Teveten Enrollment Form
Teveten® HCT (eprosartan mesylate hydrochlorothiazide)	Teveten HCT Enrollment Form
TriCor® (fenofibrate tablets)	TriCor Enrollment Form
TRILIPIX™ (fenofibric acid) delayed-release capsules	TRILIPIX Enrollment Form
Zemplar® Capsules (paricalcitol)	Zemplar Capsules Enrollment Form
Zemplar® Injection (paricalcitol)	Zemplar Injection Enrollment Form

To view the enrollment form as an Adobe Portable Document Format (PDF), you will need Adobe Acrobat Reader 3.0 or higher. If you do not have it installed on your system, clicking the button at the right will help you download a copy.

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