Get Abbvie Assist Application

The Abbvie Assist Application is designed to help individuals access Abbvie medications at no cost due to financial difficulties. This guide will assist you through the process of filling out the application online, ensuring you provide all necessary information for a successful submission.

Follow the steps to complete your Abbvie Assist Application online.

1. Click ‘Get Form’ button to obtain the application form and open it in the designated editor.
2. Begin by filling out the patient information section. Ensure you provide the patient's full name, address, date of birth, and contact information. Indicate the gender of the patient and include their Social Security number, using only the last four digits.
3. In the insurance section, indicate the Medicare enrollment status by checking 'Yes' or 'No'. If applicable, select all relevant options regarding private insurance coverage for prescriptions and state Medicaid Program.
4. Complete the income information by entering the total monthly income for the entire household and the number of individuals living in the household, particularly those under 18 years old.
5. Attach the required documentation for income verification, such as tax returns or pay stubs, to support the application.
6. Proceed to the additional permissions section, where you can authorize the Abbvie Patient Assistance Foundation to communicate with designated individuals about your application.
7. Fill out the prescriber information section. This includes details about the prescribing healthcare provider, including their name, professional designation, and contact information.
8. In the medication requested section, provide detailed information about the products required, including strength and signature instruction (Sig) for each medication.
9. Ensure that the patient and prescriber sign and date the application in all required sections, confirming that the information provided is accurate.
10. Once all sections are completed, review the application to ensure accuracy. After confirming that all required fields are filled, you can save the changes, download the form, or print it for mailing or faxing.

Complete the Abbvie Assist Application online today to ensure you receive the support you need.