Lithobid / About Patient Assistance Program

The Noven Therapeutics Patient Care Program provides financial assistance to low-income patients who do not have prescription coverage and do not have the means to pay for JDS medications. A nominal fee of $10 is charged for each prescription dispensed. The program provides assistance to people of all ages provided certain income and other eligibility requirements are met.

To learn more about whether or not you or a family member may qualify for the program and or to obtain an application, please click here or call toll free at 1-888-296-1826, Monday through Friday, 8:30 am to 5:30pm EST.

Eligibility Criteria:

Patients must meet all of the following guidelines to qualify for the JDS Patient Care Program:

Be a United States citizen or legal resident alien.
Have no prescription drug benefits through any insurer/payer/program including Medicare, VA, other state/local program or private insurer.
Have gross annual household income at or below:

Size of Family Unit	48 Contiguous States, DC	Alaska	Hawaii
1	$14,700	$18,375	$16,905
2	$19,800	$24,750	$22,770
3	$24,900	$31,125	$28,635
4	$30,000	$37,500	$34,500
5	$35,100	$43,875	$40,365
6	$40,200	$50,250	$46,230
7	$45,300	$56,625	$52,095
8	$50,400	$63,000	$57,960
For each additional family member, add:	$4,250	$5,313	$4,888

Proof of income will be required. Examples are outlined below.

Proof of Income:

Proof of monthly income for all person in the household must be attached. Acceptable documents include:

(a) Monthly pay stub (current within the last two months)
(b) Monthly benefits (Social Security, etc.) can be award letter, benefit statement, or bank statements showing automatic deposit for the current calendar year
(c) Self-employed patients must attach a copy of most current Federal Income Tax form with appropriate schedules (C and/or F)
(d) If you have no income, you must attach a note from your physician, or social worker on their letterhead stating to the best of their knowledge you have no income.

Return completed Application with proof of income to:

JDS Patient Care Program
P.O. Box 2106
Morrisville, PA 19067-0606

Or fax to:
1-800-233-9141

If you have questions, please call the JDS Patient Care Program at 1-888-296-1826. A customer service representative is available between the hours of 8:30 a.m. and 5:30 p.m. EST Monday through Friday, excluding holidays.