Tirosint

Indicated For

Hypothyroidism

About This Medication

# IBSA Patient Assistance Program Patient Guide: How to Get Tirosint at Low or No Cost ## About This Program The **IBSA Patient Assistance Program (PAP)** is a free medication program offered by IBSA Pharma Inc. to help eligible patients access Tirosint (levothyroxine sodium) at no cost. Tirosint is a prescription medication used to treat hypothyroidism by replacing thyroid hormone in the body. If you're struggling to afford this essential medication, this program may be able to help. ## Who Qualifies for the Program To be eligible for the IBSA Patient Assistance Program, you must meet ALL of the following requirements: - **U.S. Resident:** You must be a legal U.S. resident - **No Government Health Insurance:** You cannot be enrolled in Medicare, Medicaid, TRICARE, CHAMPUS, or other state or federal healthcare programs[1] - **Limited or No Prescription Insurance:** You must have no prescription insurance coverage or be underinsured[2] - **Income Requirement:** Your annual household income must fall at or below 200% of the U.S. Federal Poverty Level[2] **Important:** If you receive Medicare, Medicaid, or other government health insurance, you are not eligible for this program, even if you have high out-of-pocket costs[1]. ## Income Eligibility Breakdown Your household income must be at or below 200% of the Federal Poverty Level. While specific income thresholds are not publicly disclosed by IBSA, the 200% FPL guideline means your household income limit depends on your family size. Here's a general reference: | Family Size | Approximate 200% FPL Threshold | |---|---| | 1 person | ~$28,000 annually | | 2 people | ~$37,000 annually | | 3 people | ~$47,000 annually | | 4 people | ~$57,000 annually | *Note: These figures are approximate and based on 2026 federal poverty guidelines. Contact IBSA directly at (833) 838-3247 for exact current thresholds[1].* ## Insurance Requirements The program is designed for patients who are **uninsured or underinsured**. You cannot have active prescription insurance coverage. If you're enrolled in government health programs like Medicare or Medicaid, you are automatically ineligible, regardless of your income level[1][2]. ## Medications Available The following medications are available through the IBSA Patient Assistance Program: - **Tirosint-Sol® (Levothyroxine Sodium Oral Solution)** – Available to new patients - **Tirosint® (Levothyroxine Sodium Capsules)** – Not available to new patients[2] ## Step-by-Step Application Process ### Step 1: Download and Complete the Enrollment Form Visit tirosint.com or tirosintsol.com and download the IBSA Patient Assistance Program enrollment form. Complete all sections of the form carefully, including: - Your full name and date of birth - Your contact information - Your household income information - Your insurance status - Your prescriber's information and signature[1][2] **Important:** Your prescriber's signature is required on the application. Signature stamps are NOT acceptable—the signature must be handwritten[2]. ### Step 2: Gather Required Documentation You must provide proof of your household income. Acceptable documentation includes: - Recent tax returns - Pay stubs from two consecutive pay periods - Bank statements - Other income verification documents[2] Make copies of all documents you send, as IBSA will not return them[2]. ### Step 3: Submit Your Application You have two options for submitting your completed application and documentation: **By Mail:** IBSA Patient Assistance Program PO Box 1229 Southampton, PA 18966 **By Fax:** (833) 340-7196 *Note: Faxes are only accepted when sent directly from your prescriber's office and must include a cover page with the prescriber's contact information, medical provider address, NPI number, and patient name. Faxes without this information will be discarded[1].* ### Step 4: Receive Your Eligibility Decision Once IBSA receives your completed application, both you and your prescriber will be notified of your eligibility status[2]. ## Timeline and Medication Delivery **Processing Time:** While specific processing times are not publicly stated, you should allow time for mail delivery and application review. Contact IBSA at (833) 838-3247 if you have questions about your application status. **Initial Supply:** If approved, you will automatically be mailed your first supply of medication to your home address. The initial supply is typically a 30-90 day supply[1][8]. **Ongoing Refills:** After receiving your initial supply, you can request refills by calling the program. You will receive free medication for the remainder of the calendar year[1]. ## Reauthorization and Annual Renewal **Important:** You must re-enroll and re-qualify for the program each calendar year to continue receiving free medication[1]. This means you'll need to submit a new application and income documentation every January to maintain your eligibility for the upcoming year. ## What If Your Application Is Denied? If you don't qualify for the IBSA Patient Assistance Program, you have other options: - **Tirosint Direct Program:** A mail-order program that offers Tirosint at a reduced out-of-pocket price for patients with insurance or those who don't qualify for the free program[6] - **Discount Cards:** IBSA may offer discount programs or coupons to help reduce medication costs - **Generic Alternatives:** Ask your doctor about generic levothyroxine, which is typically less expensive than brand-name Tirosint - **Other Assistance Programs:** Contact 211.org or NeedyMeds.org to find additional patient assistance resources ## Important Disclaimers - This program is subject to IBSA's approval and your continued compliance with all eligibility requirements - You must remain uninsured or underinsured to stay in the program - If your income or insurance status changes, you must notify IBSA immediately - This guide provides general information and is not a guarantee of eligibility or program benefits - Program terms and eligibility requirements may change; contact IBSA for the most current information ## Contact Information **IBSA Patient Assistance Program** - Phone: (833) 838-3247 - Website: tirosint.com or tirosintsol.com - Mailing Address: PO Box 1229, Southampton, PA 18966 - Fax: (833) 340-7196

Program information last verified: March 30, 2026