Healthcare professionals apply for multiple medications on behalf of their patients using the HarborPath portal. You and your healthcare professional will be able to determine program eligibility and submit ONE application for your prescribed medications at one time. Within 48 hours of application approval, all medications ship directly to you or your healthcare facility.
How to Apply
Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.
- EDURANT® (rilpivirne) Tablets
- INTELENCE® (etravirine) Tablets
- Janumet XR
- JANUMET® tablets
- Maxalt MLT®
- PREZCOBIX® (darunavir 800mg/cobicistat 150mg) Tablets
- PREZISTA® (darunavir) Oral Suspension
- PREZISTA® (darunavir) Tablets
- Trusopt® opthalmic Solution