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.

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. Remember not to send program applications to the PPA.

Product(s) Covered by Program

  • A

    • AcipHex®
    • Acyclovir
    • Albuterol
    • Alclometasone Dipropionate Cream
    • Alendronate
    • Allopurinol
    • Alprazolam
    • Amiodarone
    • Amitriptyline
    • Amlodipine
    • Amlodipine Besylate
    • Aricept
    • Atenolol
    • Atenolol/Chlorthalidone
    • Atorvastatin
    • Azelastine Nasal Spray
  • B

    • Baclofen
    • Belladonna Alkaloids/Phenobarbital Tablet
    • Benazepril
    • Benazepril/HCTZ
    • Benztropine Mesylate
    • Betamethasone Aug. Dipropionate Cream
    • Betamethasone Dipropionate Cream
    • Betamethasone Valerate
    • Bicalutamide
    • Bisoprolol/HCTZ
    • Bumetanide
    • Bupropion
    • Bupropion HCL SR
    • Bupropion HCL XL
    • Buspar Dividose
    • Butalbital APAP Caffeine Tablet
  • C

    • Captopril
    • CARBATROL®
    • Carvedilol
    • Chlordiazepoxide
    • Chlorpromazine HCL
    • Chlorthalidone
    • Cilostazol
    • Citalopram
    • Clindamycin
    • Clonazepam
    • Clonidine
    • Clopidogrel
    • Colchicine Tablet
    • Cyclobenzaprine
  • D

    • Dacogen®
    • Diazepam
    • diclofenac EC
    • Diclofenac ER
    • Dicyclomine
    • Digoxin Tablet
    • Diltiazem ER
    • Diphenoxylate/Atropine
    • Divalproex DR
    • Doxazosin
    • Doxepin
  • E

    • Enalapril Maleate
    • Escitalopram tablet
    • Estradiol
    • Estropipate
    • Etodolac
  • F

    • Famotidine
    • Felodipine ER
    • Ferrous Sulfate EC tablet
    • Fibricor™
    • Finasteride
    • Fluconazole
    • Fluocinonide Cream
    • Fluoxetine
    • Fluticasone Nasal Spray
    • Folic Acid
    • Furosemide
  • G

    • Gabapentin
    • Gemfibrozil
    • Geodon®
    • Glimepiride
    • Glipizide
    • Glipizide ER
    • Glynase®PresTab®
  • H

    • Halcion®
    • Hexalen® capsule
    • Hydralazine
    • Hydrochlorothiazide/HCTZ
    • Hydrocortisone
    • Hydroxychloroquine
    • Hydroxyurea
    • Hydroxyzine HCL
    • Hydroxyzine Pamoate
    • Hyoscyamine ER
    • Hyoscyamine-SL Tablets
  • I

    • Ibuprofen
    • Indapamide
    • Irbesartan
    • Isoniazid
    • Isosorbide Mononitrate
    • Isosorbide Mononitrate ER
  • L

    • Labetalol
    • Lamotrigine
    • Leflunomide
    • Letrozole
    • Levetiracetam
    • Levetiracetam ER
    • Levoxyl®
    • Lisinopril
    • Lisinopril/HCTZ
    • Lithium Carbonate
    • Lorazepam
    • Losartan
    • Losartan/HCTZ
    • Lovastatin
  • M

    • Meclizine
    • Medroxyprogesterone Tablet
    • Meloxicam
    • Metformin
    • Metformin ER
    • Methotrexate
    • Metoclopramide
    • Metolazone
    • Metoprolol Tartrate
    • Midodrine HCl tablet
    • Midodrine HCl tablet Niacin ER tablet
    • Minocycline
    • Mirtazapine
    • Mometasone Furoate Cream
    • Montelukast Sodium
    • Mycophenolate Mofetil
  • N

    • Nabumetone
    • Nadolol
    • Naproxen Sodium
    • Niacor®
    • Nifedipine ER
    • Nitroglycerin SA
    • Nitrostat®
    • Norethindrone
    • Norethindrone Acetate
    • Norethindrone/Ethinyl Estradiol
    • Nortriptyline
    • Nystatin
    • Nystatin Cream/Ointment
    • Nystatin/Triamcinolone Cream/Ointment
  • O

    • Olanzapine
    • Omeprazole
    • Ondansetron
    • Ondansetron ODT
    • Oxandrolone tablet
    • Oxcarbazepine
    • Oxybutynin
  • P

    • Panretin® gel 0.1%
    • Pantoprazole
    • Paroxetine
    • Pentoxil®
    • Phenytoin Sodium
    • Pioglitazone HCL
    • Piroxicam
    • Potassium Chloride
    • POTASSIUM CHLORIDE EXTENDED RELEASE TABLETS
    • Pramipexole
    • Pravastatin
    • Prazosin
    • Prednisone
    • ProAir® HFA Inhaler
    • Prochlorperazine
    • Propafenone
    • Propranolol
    • Propylthiouracil
  • Q

    • Quetiapine Fumarate
    • Quinapril
  • R

    • Ramipril
    • Ranitidine
    • Repaglinide tablet
    • Risperidone
    • Ropinirole
  • S

    • Sertraline
    • Simvastatin
    • Spironolactone
    • Sprintec®
    • SSKI
    • Stavudine
    • Sucralfate tablet
    • Sulfamethoxazole/Trimethoprim
    • Sulfamethoxazole/Trimethoprim DS Tablet
    • Sulfasalazine
    • Sumatriptan Succinate
  • T

    • Tamoxifen Citrate
    • Targretin®
    • Temazepam
    • Terazosin
    • Theophyline ER
    • Ticlopidine
    • Timolol Maleate ophthalmic Solution
    • Tizanidine
    • Topiramate
    • Torsemide
    • Tramadol
    • Trandolapril
    • Trazodone
    • Tri-Sprintec®
    • Triamterene/HCTZ
    • Trianex®
  • V

    • Valproic acid capsule
    • Valsartan/HCTZ
    • Venlafaxine
    • Venlafaxine ER
    • Verapamil
    • Verapamil SR
  • W

    • Warfarin
    • Warfarin Sodium
  • Z

    • Zafirlukast
    • Zaleplon
    • Zolpidem
    • Zolpidem ER
    • Zonegran®