BI Cares Patient Assistance Program
The Boehringer Ingelheim Cares Foundation (BI Cares) Patient Assistance Program is a charitable program provided by BI Cares, an independent nonprofit organization, to improve patients’ health and lives.
The program provides Boehringer Ingelheim medicines free of charge to US patients who meet our program eligibility requirements.
Our goal is to invest our resources to help the most patients with the greatest need, including senior citizens and families with limited incomes.
To apply for the program please complete one of the following applications and follow the directions on the application for submission:
Please note:
The BI Cares Patient Assistance Program is no longer accepting applications for Pradaxa® capsules. Please discuss your treatment options with your physician.
The BI Cares Patient Assistance Program Application
(includes a number of medicines)
Are you already enrolled in our program? If yes, order your refill medication here
| English: | Editable Form | | | Flat Form (print and fill out) |
| Español: | | | Formulario Impreso (imprimir y completar) |
The BI Cares Patient Assistance Program Application - Cyltezo® and Gilotrif®
| English: | Editable Form | | | Flat Form (print and fill out) |
| Español: | | | Formulario Impreso (imprimir y completar) |
The BI Cares Patient Assistance Program Application - Ofev®
| English: | Editable Form | | | Flat Form (print and fill out) |
| Español: | | | Formulario Impreso (imprimir y completar) |
The BI Cares Patient Assistance Program Application - Spevigo®
| English: | Editable Form | | | Flat Form (print and fill out) |
| Español: | | | Formulario Impreso (imprimir y completar) |
For assistance with our program, please call our toll-free number Monday – Friday from 8:30 a.m. – 6:00 p.m. Eastern time:
BI Cares Patient Assistance Program (includes a number of medicines) - Phone: 1-800-556-8317 | Fax: 1-866-851-2827
BI Cares Patient Assistance Program - Cyltezo® Gilotrif® and Spevigo® - Phone: 1-855-297-5904 | Fax: 1-855-297-5905
BI Cares Patient Assistance Program - Ofev® - Phone: 1-855-297-5906 | Fax: 1-855-297-5907
Please note:
If you are enrolled, our charitable program will be sending you medicine free of charge to you. There is no charge for you to apply to our program, no charge to order refills during your enrollment period, no charge to call our toll-free number with questions about our program, and no charge to have your medicine shipped to you.
The Boehringer Ingelheim Cares Foundation is not affiliated with any third party individual or organization that may charge patients a fee(s) to assist them in applying to our program or ordering refills through our program. These individuals or organizations are acting independently of the Boehringer Ingelheim Cares Foundation and do not have the Foundation’s consent.
BI Cares periodically reviews program eligibility rules and makes adjustments as needed.
Related Content
Updates for Boehringer Ingelheim Cares Patient Assistance Program
Income eligibility criteria is changing for some products.
Please review the Updated Eligibility Rules to help you determine if you may be eligible for the patient assistance program.