PATIENT ASSISTANCE PROGRAM
IMG's Patient Assistance Program is designed to help financially underprivileged individuals obtain medication. Eligibility is based on Federal Poverty Guidelines. After patients fill out and submit the appropriate forms, we will be notified of patient eligibility. Upon approval into the Patient Assistance Program, a supply of medication will be shipped to IMG for dispensing to the patient.
For more information about the Patient Assistance Program, please contact the Program Manager, Kathleen Ranalli at 1-800-788-9637, extension 267.
HIPAA Requirements
The Privacy Standards set by the U.S. Department of Health and Human Services under HIPAA restricts the ways in which health care providers can use and disclose Protected Health Information (PHI). This includes information that relates to an individual's health, health care services, or payment for health care services. The enrollment process for this program requires the sharing of personally identifiable information relating to an applicant's health and finances. This information comes from the applicants themselves as well as from health care providers, insurers, and other HIPAA covered entities.
Program participants will be required to complete a HIPAA Authorization, which will accompany the program enrollment form. The authorization will allow health care providers and insurers to disclose PHI to us for the purpose of enrolling a patient in the Patient Assistance Program. By signing this authorization, program applicants will be fully informed of our role in the program and will have the opportunity to control the use
and disclosure of their personal information.
Learn more about HIPAA by clicking on the links below.
www.hhs.gov/ocr/hipaa/
www.ama-assn.org/go/patients
Participating Companies
Below is a list of the participating pharmaceutical companies. Forms for these establishments may be found at IMG.
| Abbot Laboratories | 1-800-222-6885 | www.RxHope.com |
| Astrazeneca Foundation | 1-800-424-3727 | www.astrazeneca-us.com |
| Aventis | 1-800-221-4025 | www.aventis.com/main/page.asp |
| Boehringer Ingelheim Pharmaceuticals Inc. | 1-800-542-6257 | www.boehringer-ingelheim.com |
| Bridges to Access | 1-866-728-4368 | www.BridgestoAccess.gsk.com |
| Bristol-Myers Squibb | 1-800-736-0003 | www.bms.com/landing/data |
| Dupont Pharmaceuticals Company | 1-302-992-5000 | www.dupont.com |
| Forest Pharmaceuticals Inc. | 1-314-493-7000 | www.forestpharm.com/pap |
| King Pharmaceuticals | 1-877-546-5332 | www.kingpharm.com |
| Lilly Cares Foundation, Inc. | 1-800-545-6962 | www.doctorhealthynet.com |
| Novartis | 1-800-277-2254 | www.novartis.com |
| Ortho-McNeil Pharmaceuticals | 1-800-577-3788 | www.ortho-mcneil.com |
| Patients In Need | 1-800-242-7014 | www.patientsinneed.com |
| Pfizer Connection to Care | 1-800-707-8990 | www.atdn.org/access/pa.html |
| Roche Laboratories Inc. | 1-973-235-5000 | www.rocheusa.com |
| Schering Laboratories | 1-800-656-9485 | www.myhealth.com |
| Takeda Pharmaceuticals America Inc. | 1-800-830-9159 | www.tpna.com/Default.asp |
| TAP Pharmaceuticals Inc. | 1-800-830-1015 | www.tap.com |
