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Xubex Pharmaceutical Services

Summary:

Xubex Pharmaceuticals is a company which provides assistance to patients who cannot afford the pharmaceuticals which they needs. Xubex does not charge its’ customers to join, nor do they charge monthly fees. This program is in conjunction with Bayer and Partnership for Prescription Assistance. These companies combine their resources to assist patients secure quality medical care and pharmaceuticals at an affordable rate. Applications can be submitted via traditional mail, or you may file electronically if you wish to do so.

Eligibility:

Xubex Pharmaceutical Services

- Your income must be less than or equal to 243% of the Federal Poverty Guideline for the size of your household (see chart below).

The following fees apply - $20-$30 for a three month supply, $40-$60 for a half year supply, and $80-$120 for a full year’s supply.

The medication must be sent to the physicians office.

Those eligible for Medicare Part D but not enrolled may still be eligible.

SOURCE: 2008 Poverty Chart
Family Size 100% 133% 150% 200% 250% 300%
1 $10,400 $13,832 $15,600 $20,800 $26,000 $31,200
2 $14,000 $18,620 $21,000 $28,000 $35,000 $42,000
3 $17,600 $23,408 $26,400 $35,200 $44,000 $52,800
4 $21,200 $28,196 $31,800 $42,400 $53,000 $63,600
5 $24,800 $32,984 $37,200 $49,600 $62,000 $74,400
6 $28,400 $37,772 $42,600 $56,800 $71,000 $85,200
7 $32,000 $42,560 $48,000 $64,000 $80,000 $96,000
8 $35,600 $47,348 $53,400 $71,200 $89,000 $106,800
For each additional family member $3,600 $4,788 $5,400 $7,200 $9,000 $10,800

What’s Next?

Fill out the program enrollment form located to your right. If you don’t see an enrollment form available please call Xubex Pharmaceuticals program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Other Tips

  • If you have any questions please call the Xubex Pharmaceuticals program directly
  • Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in
  • Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don’t run out of medication.
  • Do not write messy on your forms as this will delay any response
  • Call and write thank you notes to Xubex Pharmaceuticals program. Without their help millions of people will be without medication.




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    List of Medications:
    Acebutolol Capsules 200mg (Sectral), Acyclovir Tablets 200mg, 400mg (Zovirax), Albuterol Inhalation Solution (Proventil), Albuterol Tablets 2mg, 4mg (Proventil), Albuterol Tablets 2mg, 4mg (Ventolin), Alendronate Tablets 5mg, 10mg, 35mg, 70mg (Fosamax), Alendronate Tabs 5mg, 10mg, 35mg, 70mg (Fosamax), Allopurinol Tablets 100mg, 300mg (Zyloprim), Alprazolam Tablets 0.25mg, 0.5mg, 1mg, 2mg (Xanax), Amiloride/hydrochlorothiazide (Moduretic), Aminophylline Tablets 100mg, 200mg (Aminophylline), Amiodarone Tablets 200mg (Cordarone), Amitriptyline Tablets 10mg, 25mg, 50mg, 75mg, 100mg, 150mg (Elavil), Amlodipine Tablets 2.5mg, 5mg, 10mg (Norvasc), Atenolol Tablets 25mg, 50mg, 100mg (Tenormin), Atenolol/chlorthalidone Tablets 50/100mg (Tenoretic), Atropine Ophthalmic Solution 1% (Isopto Atropine), Baclofen Tablets 10mg, 20mg (Lioresal), Belladonna Alkaloids/phenobarbital Tablets (Donnatal), Benazepril Tablets 5mg, 10mg, 20mg, 40mg (Lotensin), Benazepril/hct Tablets 5mg/6.25mg, 10mg/12.5mg, 20mg/12.5mg, 20mg/25mg, 40mg (Lotensin HCT), Benztropine Tablets 0.5mg, 1mg, 2mg (Cogentin), Betamethasone Cream 0.5% (Diprosone), Betamethasone Ointment 0.5% (Diprosone), Betamethasone Dipropionate Cream 0.5% (Diprolene AF), Betamethasone Dipropionate Ointment 0.5% (Diprolene AF), Betamethasone/clotrimazole Cream (Lotrisone), Betamethasone/clotrimazole Cream (LotrisoneV), Bisoprolol/hctz Tablets 2.5mg, 5mg, 10mg (Ziac), Bumetanide Tablets 0.5mg, 1mg, 2mg (Bumex), Bupropion Tablets 75mg, 100mg (Wellbutrin), Buspirone Tablets 5mg, 10mg, 15mg (BuSpar), Captopril Tablets 12.5mg, 25mg, 50mg, 100mg (Capoten), Captopril/hctz Tablets 25mg/15mg, 25mg/25mg, 50mg/25mg (Capozide), Carbamazepine Tablets 200mg (Tegretol), Carisoprosdol Tablets 350mg (Soma), Carvedilol Tablets 3.12mg, 6.25mg, 12.5mg, 25mg (Coreg), Cetirizine Hcl Tablets 5mg, 10mg (Zyrtec), Chlordiazepoxide Tablets 5mg, 10mg, 25mg (Librium), Chlordiazepoxide/clidinium Tablets (Librax), Chlorpropamide Tablets 250mg (Diabinese), Chlorthalidone Tablets 25mg, 50mg (Thalitone), Chlorzoxazone Tablets 500mg (Parafon-Forte), Choline Magnesium Trisalicylate Tablets 500mg, 750mg, 1000mg (Trilisate), Cilostazol Tablets 50mg, 100mg (Pletal), Cimetidine Tablets 300mg, 400mg, 800mg (Tagamet), Ciprofloxacin Tablets 250mg, 500mg, 750mg (Cipro), Citalopram Tablets 10mg, 20mg, 40mg (Celexa), Clonazepam Tablets 0.5mg, 1mg, 2mg (Klonopin), Clonidine Tablets 0.1mg, 0.2mg (Catapres), Colchicine Tablets 0.6mg (Colchicine), Cromolyn Ophthalmic Ophthalmic Solution 4% (Crolom), Cyclobenzaprine Tablets 10mg (Flexeril), Diazepam Tablets 2mg, 5mg, 10mg (Valium), Diclofenac Tablets 50mg (Cataflam), Dicyclomine Tablets 10mg, 20mg (Bentyl), Digoxin Tablets 0.125mg, 0.25mg (Lanoxin), Diltiazem Tablets 120mg, 180mg, 240mg (Cardizem CD), Diltiazem Tablets 120mg, 180mg, 240mg (Tiazac), Diltiazem Tablets 30mg, 60mg, 90mg (Cardizem), Diphenoxylate/atropine Tablets 2.5/0.025mg (Lomotil), Dipivefrin Ophthalmic Solution 0.1% (Propine), Divalproex Sodium Tablets 125mg, 250mg, 500mg (Depakote), Doxazosin Tablets 1mg, 2mg, 4mg, 8mg (Cardura), Doxepin Capsules 10mg, 25mg, 50mg, 75mg, 100mg (Sinequan), Doxycycline Capsules 100mg (Vibramycin), Doxycycline Tablets 100mg (Vibramycin), Enalapril Tablets 2.5mg, 5mg, 10mg, 20mg (Vasotec), Enalapril/hctz Tablets 5/12.5mg, 10/25mg (Vaseretic), Estradiol Tablets 0.5mg, 1mg, 2mg (Estrace), Estropipate Tablets 0.75mg, 1.5mg (Ogen), Etodolac (Lodine), Etodolac Tablets 200mg, 300mg, 400mg (Lodine), Famotidine Tablets 20mg, 40mg (Pepcid), Fluconazole Tablets 100mg, 150mg, 200mg (Diflucan), Fluocinolone Topical Cream 0.01%/0.025% (Synalar), Fluocinolone Topical Ointment 0.01%/0.025% (Synalar), Fluocinonide Topical Cream 0.05% (Lidex), Fluoxetine Tablets 10mg, 20mg (Prozac), Fluphenazine Tablets 1mg, 2.5mg, 5mg, 10mg (Prolixin), Fluphenazine Injectable Injection 25mg/ml (Prolixin Decanoate), Flurazepam Tablets 15mg, 30mg (Dalmane), Flurbiprofen Ophthalmic Drops 0.03% (Ocufen), Fluriprofen Tablets 50mg, 100mg (Ansaid), Fluticasone Nasal Spray Nasal Spray 50mcg (Flonase), Folic Acid Tablets 1mg (Folvite), Foltab Tablets 800mg/ml (Folgard), Fosinopril Tablets 10mg, 20mg, 40mg (Monopril), Furosemide Tablets 20mg, 40mg, 80mg (Lasix), Gabapentin Capsules 100mg, 300mg, 400mg (Neurontin), Gemfibrozil Tablets 600mg (Lopid), Glimepiride Tablets 1mg, 2mg, 4mg, (Amaryl), Glipizide Tablets 5mg, 10mg (Glucotrol), Glyburide Tablets 1.25mg, 2.5mg, 5mg (DiaBeta/micronase), Glyburide Tablets 3mg, 6mg (Glynase PresTab), Glyburide/metformin Tablets 1.25/250mg, 2.5/500mg, 5/500mg (Glucovance), Guaifenesin Tablets 400mg (Liquibid), Guanfacine Tablets 1mg, 2mg (Tenex), Haloperidol Tablets 0.5mg, 1mg, 2mg, 5mg (Haldol), Hydralazine Tablets 25mg, 50mg (Apresoline), Hydrochlorothiazide Tablets 25mg, 50mg (Esidrix), Hydrochlorothiazide Tablets 25mg, 50mg (HydroDIURIL), Hydrochlorothiazide/triamterene Tablets 37.5/25mg, 75mg/50mg (Dyazide), Hydrochlorothiazide/triamterene Tablets 37.5/25mg, 75mg/50mg (Maxzide), Hydrocortisone Suppository (Anusol-HC), Hydrocortisone Tablets 5mg, 10mg, 20mg (Cortef), Hydroxychloroquine Tablets 200mg (Plaquenil), Hydroxyzine Capsules 25mg, 50mg (Vistaril), Hyoscyamine Tablets 0.125mg/ml (Levsin-SL/Oral), Ibuprofen Tablets 400mg, 600mg, 800mg (Motrin), Indapamide Tablets 1.25mg, 2.5mg (Lozol), Ipratropium Inhalation Solution (Atrovent), Ipratropium Bromide/albuterol Sulfate Inhalation Solution (DuoNeb), Isoniazid Tablets 100mg, 300mg (Isoniazid), Isosorbide Dinitrate Tablets 5mg, 10mg, 20mg (Isordil), Isosorbide Mononitrate Tablets 20mg (Ismo), Isosorbide Mononitrate Tablets 30mg, 60mg, 120mg (Imdur), Ketoprofen Capsules 5mg, 75mg (Orudis), Labetalol Tablets 100mg, 200mg, 300mg (Trandate), Levobunolol Ophthalmic Ophthalmic Solution 0.25%, 0.5% (Betagan), Levothyroxine Tablets 137mcg (Synthroid), Levothyroxine Tablets 25mcg, 50mcg, 75mcg, 100mcg, 112mcg, 125mcg, 150mcg, 175mcg, 200mcg (Synthroid), Lisinopril Tablets 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg (Prinivil), Lisinopril/hctz Tablets 10/12.5mg, 20/12.5mg, 20/25mg (Zestoretic), Lithium Capsules 300mg (Eskalith), Lorazepam Tablets 0.5mg, 1mg, 2mg (Ativan), Lovastatin Tablets 10mg, 20mg, 40mg (Mevacor), Meclizine Tablets 12.5mg, 25mg (Antivert), Medroxyprogesterone Tablets 2.5mg, 5mg, 10mg (Amen), Medroxyprogesterone Acetate Tablets 2.5mg, 5mg, 10mg (Provera), Meloxicam Tablets 7.5mg, 15mg (Mobic), Metformin Tablets 500mg, 850mg, 1000mg (Glucophage), Metformin Tablets 500mg, 750mg (Glucophage XR), Methocarbamol Tablets 500mg, 750mg (Robaxin), Methotrexate Injection 25mg/ml (Rheumatrex), Methotrexate Tablets 2.5mg (Rheumatrex), Methyldopa Tablets 250mg, 500mg (Aldomet), Methylprednisolone Tablets 4mg (Medrol), Metoprolol Tablets 25mg, 50mg, 100mg (Lopressor), Mirtazapine Tablets 15mg, 30mg, 45mg (Remeron), Nadolol Tablets 20mg, 40mg, 80mg (Corgard), Naproxen Tablets 250mg, 375mg, 500mg (Naprosyn), Niacin Tablets 500mg (Niacin TD Slow-Release), Nicardipine Capsules 20mg,30mg (Cardene), Nortriptyline Capsules 25mg, 50mg, 75mg (Pamelor), Nystatin Cream (Mycostatin), Nystatin Ointment (Mycostatin), Nystatin/triamcinolone Topical Cream 100,000/unit/gm-0.1% (60gm) (Mycolog-II), Omeprazole Tablets 20mg (Prilosec), Ondansetron Tablets 4mg, 8mg (Zofran), Oxybutynin Tablets 5mg (Ditropan), Pentoxifylline Tablets 400mg (Trental), Phenobarbital Tablets 15mg, 30mg, 60mg, 100mg (Phenobarbital), Phenobarbital Tablets 15mg, 30mg, 60mg, 100mg (Solfoton), Pilocarpine Eye Drops 0.5%, 1%, 2%, 3%, 4%, 6% (Pilocar), Piroxicam Capsules 10mg, 20mg (Feldene), Potassium Chloride Powder Packet 20 Meq (Klor-Con), Potassium Chloride Tablets 10meq, 20meq (Klor-Con), Pravastatin Tablets 10mg, 20mg, 40mg (Pravachol), Prednisone Tablets 2.5mg, 5mg, 10mg, 20mg, 50mg (Deltasone), Prochlorperazine Maleate Tablets 5mg, 10mg (Compazine), Propafenone Tablets 150mg (Rythomol), Propranolol Tablets 10mg, 20mg, 40mg, 80mg (Inderal), Quinapril Tablets 5mg, 10mg, 20mg, 40mg (Accupril), Ramipril Capsules 2.5mg, 5mg, 10mg (Altace), Ranitidine Tablets 150mg, 300mg (Zantac), Ropinirole Capsules 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg (Requip), Salsalate Tablets 500mg, 750mg (Disalcid), Selegiline Tablets 5mg (Eldepryl), Sertraline Tablets 25mg, 50mg, 100mg (Zoloft), Simvastatin Tablets 5mg, 10mg, 20mg, 40mg, 80mg (Zocor), Sotalol Tablets 80mg, 120mg, 160mg, 240mg (Betapace), Spironolactone Tablets 25mg (Aldactone), Sulfasalazine Tablets 500mg (Azulfidine), Sulindac Tablets 150mg, 200mg (Clinoril), Temazepam Capsules 15mg, 30mg (Restoril), Terazocin Tablets 2mg, 5mg, 10mg (Hytrin), Theophylline Tablets 100mg, 200mg, 300mg (Theo-Dur), Thiothixene Capsules 1mg, 2mg, 5mg, 10mg (Navane), Thyroid Tablets 15mg, 30mg, 60mg, 90mg, 120mg, 180mg (Thyroid), Ticlodipine Tablets 250mg (Ticlid), Timolol Tablets 5mg (Blocadren), Timolol Ophthalmic Ophthalmic Solution 0.25%, 0.5% (Timoptic), Tizanidine Tabs 2mg, 4mg (Zanaflex), Torsemide Tablets 5mg, 10mg, 20mg, 100mg (Demadex), Tramadol Tablets 50mg (Ultram), Trazodone Tablets 50mg, 100mg, 150mg (Desyrel), Triamcinolone Topical Cream 0.1% (Kenalog), Triamcinolone Topical Ointment 0.1% (Kenalog), Trihexyphenidyl Tablets 2mg (Artane), Trimethoprim/sulfamethoxazole Tablets 800/160mg (Septra DS), Trimethoprim/sulfamethoxazole Tablets 800/160mg (Bactrim DS), Verapamil Tabets 120mg, 180mg, 240mg (Isoptin SR), Verapamil Tablets 120mg, 180mg, 240mg (Calan SR), Verapamil Tablets 80mg, 120mg (Calan), Verapamil Tablets 80mg, 120mg (Isoptin), Warfarin Tablets 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, 10mg (Coumadin), Warfarin Tablets 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, 10mg (Jantoven), Zaleplon 5mg, 10mg 2 (Sonata), Zolpidem Tablets 5mg, 10mg (Ambien), Zonisamide Capsules 25mg, 100mg (Zonegran)

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