Pharmacy Assistance Fund
The Fairview Pharmacy Assistance Fund provides one-time prescription assistance to patients experiencing financial hardship. Eligible patients typically have no prescription drug benefits or have exhausted their coverage. They also must not be eligible for, or have access to, alternative sources of coverage or funding (Medicaid, MinnesotaCare, Medicare, etc.). All applications are reviewed on a case-by-case basis.
1. You have no insurance coverage or benefits for prescription medicines or your coverage has been exhausted.
2. Your total gross annual household income is at or below two times the Federal Poverty Level (see chart below).
3. You have not previously utilized the Fairview Pharmacy Emergency Fund during the calendar year.
4. Your request does not exceed $500.00.
|Family size||Annual Gross Income (2013)|
Family size is the total number of persons in household including yourself and those for whom you are financially responsible.
Annual Gross Income includes income from all earners in the household before taxes and deductions.
How to Apply
Please complete the Fairview Pharmacy Assistance Fund Worksheet. Submit worksheet with proof of income to:
Fairview Pharmacy Services