Patient Assistance Application for HUMIRA …

Patient Assistance Application for HUMIRA ( adalimumab ). The abbvie Patient Assistance Foundation provides abbvie medicines at no cost 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. We review all applications on a case-by-case basis to support the abbvie Patient Assistance Foundation's purpose of providing products at no cost to individuals in need. Checklist for submitting an Application : Ensure all sections of the Application are completed. Failure to complete required information will delay the review process. To complete the enrollment process, information and signatures from both the Prescriber and the Patient are required.

©2016 AbbVie Patient Assistance Foundation H-APP1-16G-2 July 2016 Printed in U.S.A. Patient Assistance Application for HUMIRA ® (adalimumab)

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  Applications, Patients, Assistance, Humira, Patient assistance application for humira, Abbvie, Adalimumab, Abbvie patient assistance

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