Apply to Teva Cares Foundation Patient Assistance Program
Free Teva medicines (Ajovy, Austedo, Uzedy and others) for US residents with household income up to 300% of the poverty level. Apply directly with the program; here is what it asks and what happens next.
Who can apply?
| Household | 1 person | 2 people | 3 people | 4 people |
|---|---|---|---|---|
| Yearly income up to | $47,880 | $64,920 | $81,960 | $99,000 |
Total pre-tax household income at or below 300% FPL (effective January 31, 2025; used for 2026 enrollment).
Applicants must disclose all coverage. If insurance requires a prior authorization or formulary exception, the patient must pursue it, appeal a denial, and attach the outcome letter. Patients whose plan or employer requires applying to Teva Cares as a condition of coverage are not eligible. Medicare Part D: under 150% FPL must first send an Extra Help denial. Medicaid and VA not addressed.
Not for people whose employer or plan sends them to the program as a condition of coverage.
Then what?
Sign
- application (optional electronic income verification consent)
Attach
- proof of income from all sources for all household members, unless electronic income verification consent is signed
- prior authorization or formulary exception outcome letter if required by insurance
- Extra Help denial if under 150% FPL
Your prescriber
- completes and signs the application
- provides a valid prescription
Send
- Fax 1-877-438-4404
- Mail to Teva Cares Foundation, P.O. Box 501827, San Diego, CA 92150
Rather apply online? Apply on the Teva Cares Foundation Patient Assistance Program site.
Questions: call Teva Cares Foundation Patient Assistance Program at 1-877-237-4881. Up to 12 months, sometimes through the end of the calendar year; reapply each year..
Free. No fee to apply, participate or receive medicine; not affiliated with third parties who charge to help with enrollment. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.