Boehringer Ingelheim Pharmaceuticals, Inc
Boehringer Ingelheim Cares Foundation, Inc
Sponsor Organization
Boehringer Ingelheim Pharmaceuticals, Inc
Prescription Medication Assistance Organization Contact
Boehringer Ingelheim Cares Foundation
c/o Express Scripts Specialty Distribution Services, Inc
PO Box 66555
St Louis, MO 63166-6555
Phone: (800) 556-8317
Fax: (866) 851-2827
Medications sent to: Patient’s Doctor
Prescription Medications/Products Covered:
Aggrenox Capsules
Atrovent Inhalation Aerosol
Catapres-TTS Transdermal Patch
Combivent Inhalation Aerosol
Flomax Capsules
Micardis HCT Tablets
Micardis Tablets
Mirapex Tablets
Mobic Tablets
Spiriva HandiHaler
Viramune Oral Suspension
Viramune Tablets
Program Information And Resources:
Patient Assistance Program (PAP) Application Form (Spanish version)
Program Information And Resources:
Patient Assistance Program (PAP) Application Form
Program Information And Resources:
Apply Online
Program Information And Resources:
Program Eligibility Requirements:
Eligibility to be determined solely by BIPI. Patient must be a U.S. citizen or legal resident ineligible for prescription drug assistance through Medicaid or private insurance. Patient must meet established financial criteria.
Additional Information and/or Requirements (known):
All requests are reviewed and approved on a case-by-case basis. Application Form form, prescription, and patient's income documentation are required. Maximum of three-month supply may be provided per requeSt Complete financial re-Application Form is required annually. Renewal requests within the same year require only the Application Form form and a prescription. Program is subject to change without notice. Current program specifics can be obtained by calling (800) 556-8317.
