What is Teva Cares Foundation?

The Teva Cares Foundation is a nonprofit organization dedicated to ensuring that cost is not a barrier to receiving treatment. Through the Teva Cares Foundation Patient Assistance Programs, we provide Teva medications at no cost to patients who meet certain insurance and income criteria.

What drugs are available through your Patient Assistance Programs?

The following medications are currently available through the Teva Cares Foundation Patient Assistance Programs:

You may qualify for the Teva Cares® Foundation Fentora® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Fentora®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Bendeka Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Bendeka.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Cinqair® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Cinqair®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 844-838-2213 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Gabitril® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Gabitril®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Nuvigil® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Nuvigil®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Tev-Tropin® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Tev-Tropin®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Treanda® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Treanda®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Trisenox® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Trisenox®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Cyclosporine® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Cyclosporine®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Cyclosporine Oral® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Cyclosporine Oral®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation SYNRIBO® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed SYNRIBO®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation GALZIN® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed GALZIN®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Orap® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Orap®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Proglycem® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Proglycem®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation ProAir® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed ProAir®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation ProAir Respiclick® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed ProAir Respiclick®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Qnasl® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Qnasl®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Qvar® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Qvar®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.

You may qualify for the Teva Cares® Foundation Granix® Patient Assistance Program if you answer “YES” to the following questions:

  1. You have been prescribed Granix®.
  2. You do not have prescription drug coverage.
  3. Your yearly household income does not exceed the following:

Income Guidelines for Teva Cares Foundation Cyclosporine Capsules Modified, Cyclosporine Oral Solution Modified, FENTORA®, GABITRIL®, GALZIN®, NUVIGIL®, ORAP®, ProAir® HFA, ProAir RespiClick®, QNASL, QVAR®, Proglycem® Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $36,180 $48,720 $61,260 $73,800 $86,340

Income Guidelines for Teva Cares Foundation Bendeka (bendamustine HCI), GRANIX (tbo-filgrastim), TREANDA® (bendamustine HCI) for Injection, TRISENOX® (arsenic trioxide) injection, SYNRIBO (Omacetaxine mepesuccinate) for injection Patient Assistance Program

Number of People in Your Household 1 2 3 4 5
Total Annual Income $60,300 $81,200 $102,100 $123,000 $143,900

Click here to download an application and instructions, or call 877-237-4881 to receive an application by mail or fax. We are staffed to assist you Monday through Friday, from 9:00 AM – 8:00 PM Eastern time. Applications must be completed and signed by the patient and the physician.