UCB Cares Patient Assistance Program

Requirements for uninsured applicants

• Patient must be at or below 300% federal poverty level to qualify
  • View federal poverty guidelines
• Medications are shipped to the patient home automatically
• If ordering a controlled medication you must send a copy of patients ID with the application
  • Remember to send in a new hardcopy after 6 months for their remaining fills if RX is a controlled medication
• If you do not list your name under authorized individuals on the first page of the application the company will not discuss the patients enrollment or refills with you even if you are from the physician’s office
• Applications are good for 1 year from the date approved by the program

Requirement for Medicare Part D applicants

• Medicare Part D enrollees are approved on a case by case basis
• Applications for Medicare Part D enrollees are valid until December 31st of the current enrollment year