Rx Outreach

Express-Scripts

Rx Outreach is a low-cost prescription medication program for people in need across the U.S. Prescriptions are mailed directly to the patient after receipt of an Rx Outreach form, a prescription, and payment.
Contact Information
Rx Outreach
P.O. Box 66536
St. Louis, MO 63166-6536
1-(800) 769-3880 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to PPA.
Eligibility:
Rx Outreach is a patient assistance program that offers patients access to more than 400 prescription medications. Patients must qualify based on income.
Other Information:
Medications in this program are available in 90-day and/or 180-day supplies. Over 150 medications are available in a 6-month supply for just $20.
Product(s) covered by program:
  • AcipHex®
  • Acyclovir
  • Alclometasone Dipropionate Cream
  • Alendronate
  • Allopurinol
  • Alprazolam
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amlodipine/Benazepril
  • Aricept®
  • Atenolol
  • Atenolol/Chlorthalidone
  • Atorvastatin
  • Baclofen
  • Benazepril
  • Benazepril/HCTZ
  • Benztropine
  • Betamethasone Dipropionate Cream, Augmented
  • Bicalutamide
  • Bisoprolol/HCTZ
  • Bumetanide
  • Bupropion
  • Bupropion HCL SR
  • Bupropion HCL XL
  • Buspirone
  • Captopril
  • Carbamazepine
  • Carbidopa/Levodopa
  • Carbidopa/Levodopa SR
  • Carvedilol
  • Chlorpromazine HCL
  • Chlorthalidone
  • Cilostazol
  • Citalopram
  • Clindamycin
  • Clonazepam
  • Clonidine
  • Clopidogrel
  • Cyclobenzaprine
  • Dacogen®
  • Diazepam
  • diclofenac EC
  • Diclofenac ER
  • Dicyclomine
  • Digoxin
  • Diltiazem ER
  • Diphenoxylate/Atropine
  • Divalproex DR
  • Doxazosin
  • Doxepin
  • Enalapril Maleate
  • Enalapril/HCTZ
  • Escitalopram tablet
  • Estradiol
  • Estropipate
  • Etodolac
  • Famotidine
  • Felodipine ER
  • Finasteride
  • Fluconazole
  • Fluoxetine
  • Fluticasone Nasal Spray
  • Folic Acid
  • Furosemide
  • Gabapentin
  • Gemfibrozil
  • Geodon®
  • Glimepiride
  • Glipizide
  • Glipizide ER
  • Glyburide
  • Glyburide Micronized
  • Glyburide/Metformin
  • Haloperidol
  • Hexalen® capsule
  • Hydralazine
  • Hydrochlorothiazide/HCTZ
  • Hydroxychloroquine
  • Hydroxyurea
  • Hydroxyzine HCL
  • Hydroxyzine pamoate
  • Ibuprofen
  • Indapamide
  • Irbesartan
  • Irbesartan/HCTZ
  • Isoniazid Tablets
  • Isosorbide Mononitrate
  • Isosorbide Mononitrate ER
  • Labetalol
  • Lamotrigine
  • Leflunomide
  • Letrozole
  • Levetiracetam
  • Levetiracetam ER
  • Levothyroxine
  • Lisinopril
  • Lisinopril/HCTZ
  • Lithium Carbonate
  • Lorazepam
  • Losartan/HCTZ
  • Lovastatin
  • Meclizine
  • Medroxyprogesterone
  • Meloxicam
  • Metformin
  • Metformin ER
  • Methotrexate Tablets
  • Metoclopramide
  • Metolazone
  • Metoprolol
  • Minocycline
  • Mirtazapine
  • Mometasone Furoate Cream
  • Mometasone Furoate Ointment
  • Montelukast Sodium
  • Mycophenolate Mofetil
  • Nabumetone
  • Naproxen
  • Naproxen Sodium
  • Nifedipine ER
  • Nitroglycerin SA
  • Norethindrone
  • Norethindrone Acetate
  • Norethindrone/Ethinyl Estradiol
  • Nortriptyline
  • Nystatin
  • Olanzapine
  • Omeprazole
  • Ondansetron
  • Ondansetron ODT
  • Oxcarbazepine
  • Oxybutynin
  • Panretin® gel 0.1%
  • Pantoprazole
  • Paroxetine
  • Pentoxifylline ER
  • Phenytoin Sodium
  • Pioglitazone HCL
  • Potassium Chloride ER tablet
  • Potassium Chloride, Powder
  • Potassium Citrate
  • Pramipexole
  • Pravastatin
  • Prazosin
  • Prednisone
  • ProAir® HFA Inhaler
  • Prochlorperazine
  • Propafenone
  • Propranolol
  • Propylthiouracil
  • Quetiapine Fumarate
  • Quinapril
  • Ramipril
  • Ranitidine
  • Risperidone
  • Ropinirole HCL
  • Sertraline
  • Simvastatin
  • Spironolactone
  • Spironolactone/HCTZ
  • Sprintec®
  • Sulfamethoxazole/Trimethoprim DS
  • Sulfasalazine
  • Sumatriptan Succinate
  • Tamoxifen Citrate
  • Tamsulosin capsule
  • Temazepam
  • Terazosin
  • Theophyline ER
  • Ticlopidine
  • Tizanidine
  • Topiramate
  • Tramadol
  • Trandolapril
  • Trazodone
  • Tri-Sprintec®
  • Triamterene/HCTZ
  • Valsartan/HCTZ
  • Venlafaxine
  • Venlafaxine ER
  • Verapamil
  • Verapamil SR tablet
  • Warfarin
  • Zafirlukast
  • Zaleplon
  • Zolpidem
  • Zolpidem ER