AbbVie Patient Assistance Program

Requirements for uninsured applicants

• Patients must be at or below 200% federal poverty level to qualify.
  • View federal poverty guidelines
• For Depakote you must be an existing patient or have documented seizures, epilepsy, or brain injury to receive this medication
• You do not have to send a prescription with the application, the application serves as the prescription
• Medications are shipped to the physician’s office, they are not able to mail to the patient’s home
• Will not accept 4506-T form for income
• Applications are good for 1 year from the date written

Requirement for Medicare Part D applicants

• Medicare part D enrollees are approved on a case by case basis
  • If application is denied, you can submit an appeal letter with a list of monthly household expenses for review
• Applications for Medicare Part D enrollees are valid until December 31st of current year