This program assists eligible individuals in obtaining limited FDA-approved therapeutic drugs if there is a waiting period before

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.

Product(s) Covered by Program

  • 3

    • 3TC
  • A

    • ABILIFY® Oral Solution
    • Aczone®
    • Agenerase®
    • Aldara
    • Alprazolam
    • Ambien®
    • Ancobon
    • Androderm
    • Androgel® 1.62% and 1.0%
    • Antabuse
    • Aptivus®
    • Atarax
    • Ativan
    • Atripla®
    • AZT
  • B

    • Benadryl
    • Biaxin® Filmtab
    • Biaxin® XL Filmtab
  • C

    • Campral
    • Celexa
    • Chantix®
    • Citrovorum
    • Combivir®
    • Compazine
    • CRIXIVAN®
    • Cymbalta® (duloxetine) delayed release capsules
  • D

    • d4T
    • Daraprim®
    • Darvocet A500™
    • ddC
    • ddI
    • DDS
    • Depakote® Sprinkle Capsules*
    • Depakote®*
    • Desyrel Dividose tablet
    • Detrol®
    • Dilantin®
    • Doryx
  • E

    • EDURANT® (rilpivirne) Tablets
    • Elavil
    • Enablex®
    • Epivir®
    • Epzicom®
  • F

    • Fortovase
    • Fuzeon
  • G

    • Geodon®
    • Glucophage
    • Gyne-Lotrimin
  • H

    • HIVID
  • I

    • Imodium
    • INH
    • INTELENCE® (etravirine) Tablets
    • Invirase
    • ISENTRESS®
  • K

    • KALETRA®
    • KALETRA® Oral Solution
    • Keflex
    • Klonopin
  • L

    • Lamictal®
    • Lamisil®
    • LEVAQUIN® (levofloxacin) Tablets/Oral Solution
    • Lexiva®
    • Lipitor®
    • Lomotil®
    • Lopid®
    • Lopressor
    • Lyrica®
  • M

    • Megace ES®
    • Megace Oral Suspension
    • Mepron®
    • Methadose
    • Microzide
    • Motrin®
    • Myambutol
    • Mycobutin®
    • Mycostatin
  • N

    • Neurontin®
    • NEXAVAR®
    • NEXIUM® (esomeprazole magnesium) Delayed Release Capsules
    • Nizoral®
    • Norpramin
    • Norvir® Oral Solution
  • O

    • Oxandrin
  • P

    • Paxil CR®
    • Paxil®
    • Pepcid tablets and oral Suspension
    • Peridex
    • Pertofrane
    • Phenobarbital
    • Pravachol®
    • Premarin Vaginal Cream®
    • PREZISTA® (darunavir) Oral Suspension
    • PREZISTA® (darunavir) Tablets
    • Prilosec
    • Protonix®
    • Provera®
    • Prozac® (fluoxetine)
  • R

    • Rescriptor®
    • Restoril™ (temazepam)
    • Retrovir®
    • ReVia
    • Reyataz®
    • Rocephin
    • Roxicodone® (oxycodone hydrochloride)
  • S

    • Selzentry®
    • Septra
    • SMZ/TMP
    • SPORANOX® (itraconazole) Capsules
    • Suprax
    • Sustiva®
    • Symmetrel
  • T

    • Tegretol
    • Toprol® XL
    • TriCor®
    • Trizivir®
    • Truvada®
  • U

    • ULTRAM® (tramadol HCL) Tablets
  • V

    • Valcyte
    • Valtrex®
    • Ventolin® HFA
    • Veregen
    • Vfend®
    • Vicodin Tablets
    • Videx
    • Videx EC
    • Viramune® Oral Suspension
    • Vistaril®
  • W

    • Wellcovorin
  • Z

    • Zantac®
    • Zerit®
    • Zestril® Tablets
    • Zetia®
    • Ziagen®
    • Zithromax®
    • Zofran®
    • Zoloft®
    • Zovirax®