Patient Assistance Programs List by Drug Name - Updated 1/19/11

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1 ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA Tel: (510) Fax: (510) Date: January 19, 2011 To: HIV / AIDS Community From: Thomas Mosmiller Alameda County AIDS Drug Assistance Program (ADAP) Coordinator Subject: Updated s List by Drug Name We have recently updated this list to include information about Videx and Zerit. Ms. Jessie Lee, an intern at our office, gathered and compiled the attached metrial for your reference. This list is composed of medications currently used to treat HIV / AIDS. Also, this list only includes basic eligibility and application information. If you would like further information or the drug you re looking for is not in the list, you can look for the services available at Prescription Assistance Page 1 of 8 January 19, 2011

2 Aptivus Atripla Boehringer Ingelheim Pharmaceuticals, Inc. & Gilead Sciences, LLC Boehringer Ingelheim CARES Foundation, Inc. P.O. Box St. Louis, MO (800) (phone) 1-(866) (fax) Atripla PO Box 788 San Bruno, CA (866) (phone) 1-(866) (fax) Boehringer_Ingelheim_Phar U.S. citizen or legal resident of the U.S. annual household maceuticals_inc.boehringer_ing income of between 135% and 200% of the FPL elheim_cares_foundation_pat ient_assistance_program_for_m edicare_beneficiaries.810.pdf BristolMyers_Squibb Gilead_S ciences_llc.atripla_patient_assist ance_program.719.pdf Atripla Gilead Sciences Inc. 1-(800) (phone) Combivir GlaxoSmithKline 1-(866) (phone) Combivir GlaxoSmithKline 1-(866) (phone) Combivir Crixivan Merck and Co., Inc. SUPPORT P.O. Box 305 San Bruno, CA (800) (phone) 1-(866) (fax) pi_circulars/c/crixivan.html Emtriva Gilead Sciences Inc. 1-(800) (phone) Epivir GlaxoSmithKline 1-(866) (phone) Epivir GlaxoSmithKline 1-(866) (phone) patients for whom no alternative source of coverage can be identified. Patients must reside in the United States and have a prescription for ISENTRESS and/or CRIXIVAN from a doctor licensed in the United States. Page 2 of 8 January 19, 2011

3 Epivir Epzicom GlaxoSmithKline 1-(866) (phone) Epzicom GlaxoSmithKline 1-(866) (phone) Epzicom Fuzeon Roche Laboratories Inc. Fuzeon P.O. Box St. Louis, MO (877) (phone) Intelence Johnson & Johnson Patient Assistance Foundation, Inc. Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program P.O. Box Charlotte, NC (800) (phone) 1-(888) (fax) Johnson Johnson_Patient_Assi stance_foundation_inc.johnson J ohnson_patient_assistance_founda tion_inc_patient_assistance_progra m.3018.pdf Intelence Invirase Roche Laboratories Inc. Roche HIV Therapy Patient Assistance Program P.O. Box St. Louis, MO (800) (phone) Page 3 of 8 January 19, 2011

4 SUPPORT patients for whom no alternative source of coverage can be P.O. Box identified. Patients must reside in the United States and have a Isentress Merck and Co., Inc. San Bruno, CA pi_circulars/c/crixivan.html prescription for ISENTRESS and/or CRIXIVAN from a 1-(800) (phone) doctor licensed in the United States. 1-(866) (fax) Kaletra Abbott Abbott Patient Assistance Foundation Virology PO Box 270 Somerville, NJ (800) (phone) 1-(866) (fax) Lexiva GlaxoSmithKline 1-(866) (phone) Lexiva GlaxoSmithKline 1-(866) (phone) Lexiva Abbott.Abbott_Patient_Assistanc case-by-case basis e_foundation_virology_program.3 99.pdf Norvir Abbott Abbott Patient Assistance Foundation Virology PO Box 270 Somerville, NJ (800) (phone) 1-(866) (fax) Abbott.Abbott_Patient_Assistanc case-by-case basis e_foundation_virology_program.3 99.pdf Prezista Johnson & Johnson Patient Assistance Foundation, Inc. Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program P.O. Box Charlotte, NC (800) (phone) 1-(888) (fax) Johnson Johnson_Patient_Assi stance_foundation_inc.johnson J ohnson_patient_assistance_founda tion_inc_patient_assistance_progra m.3018.pdf Page 4 of 8 January 19, 2011

5 Prezista Reayataz Access Virology Reayataz Rescriptor GlaxoSmithKline 1-(866) (phone) Rescriptor GlaxoSmithKline 1-(866) (phone) Rescriptor Retrovir GlaxoSmithKline 1-(866) (phone) Retrovir GlaxoSmithKline 1-(866) (phone) Retrovir Page 5 of 8 January 19, 2011

6 Reyataz Access Virology Reyataz Selzentry GlaxoSmithKline 1-(866) (phone) Selzentry GlaxoSmithKline 1-(866) (phone) Selzentry Sustiva Access Virology Sustiva Trizivir GlaxoSmithKline 1-(866) (phone) Page 6 of 8 January 19, 2011

7 Trizivir GlaxoSmithKline 1-(866) (phone) Trizivir Truvada Gilead Sciences Inc. 1-(800) (phone) Videx Access Virology Viracept GlaxoSmithKline 1-(866) (phone) Viracept GlaxoSmithKline 1-(866) (phone) Viracept Viramune Boehringer Ingelheim Pharmaceuticals, Inc. Boehringer Ingelheim CARES Foundation, Inc. P.O. Box St. Louis, MO (800) (phone) 1-(866) (fax) Viread Gilead Sciences Inc. 1-(800) (phone) Boehringer_Ingelheim_Pharmac U.S. citizen or legal resident of the U.S. annual household euticals_inc.boehringer_ingelheim_ income of between 135% and 200% of the FPL CARES_Foundation_Patient_Assist ance_program_for_medicare_benef iciaries.810.pdf Page 7 of 8 January 19, 2011

8 Zerit Access Virology Ziagen Page 8 of 8 January 19, 2011

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