Tirosint

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:

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