Patient Assistance Program

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The Boehringer Ingelheim Cares Foundation Patient Assistance Program (BI-PAP) makes Boehringer Ingelheim Pharmaceuticals, Inc. products available to patients who are without pharmaceutical insurance coverage, and who meet certain household income levels. The Program is geared toward helping provide medications to those who need it most, including senior citizens and families living on limited incomes. The products included in the program are:

• AGGRENOX^® (aspirin/extended-release dipyridamole) capsules
• APTIVUS^® (tipranavir) capsules
• ATROVENT^® HFA (ipratopium bromide) inhalation aerosol
• CATAPRES-TTS^® (clonidine) transdermal patch
• COMBIVENT^® (ipratropium bromide and albuterol sulfate) inhalation aerosol
• FLOMAX^® (tamsulosin HCL) capsules
• MICARDIS^® (telmisartan) Tablets; and MICARDIS HCT (telmisartan and hydrochlorothiazide) tablets
• MIRAPEX^® (pramipexole dihydrochloride) tablets
• SPIRIVA^® HandiHaler^® (tiotropium bromide inhalation powder)
• VIRAMUNE^® (nevirapine) tablets and oral suspension

To be eligible for the BI-PAP, patients must meet the following criteria:

• Patient must be a U.S. citizen or legal resident of the U.S.
• Patient and physician must submit a completed, signed application
• Patient must meet certain financial criteria (depending upon the family size, the income criteria is approximately 200% of the federal poverty level)
• Patient must not have access to private, public or government insurer drug coverage.

To receive an application or inquire about the BI-PAP, please call 1-800-556-8317. Please note, while people of all ages are eligible for the program, applications can be sent only to people at least 18 years of age. To apply online go to www.RxHope.com.

Click here for the electronic version (Adobe Acrobat PDF) of the BI-PAP application. You and your healthcare provider must complete the form in its entirety and mail it to the address shown on the application. Acrobat reader is required to open the application. Click on the link below to download Acrobat Reader.

Additional information about other companies' Patient Assistance Programs can be found at the Partnership for Prescription Assistance (PPA) .

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