Blaine Patient Assistance Program

Blaine Company

The Boehringer Ingelheim CARES Foundation Patient Assistance Program makes Boehringer Ingelheim Pharmaceuticals, Inc., products available to patients who are without pharmaceutical insurance coverage, and who meet certain household income levels. The program is geared toward helping provide medications to those who need it most, including senior citizens and families living on limited incomes.
Contact Information
Boehringer Ingelheim CARES Foundation, Inc.
P.O. Box 66555
St. Louis, MO 63166-6555
1-(800) 556-8317 (phone)
1-(866) 851-2827 (fax)
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. Do NOT send it to RxResource.
Patient must be a U.S. citizen or legal resident of the U.S. Patient and physician must submit a completed, signed application along with a prescription for the medication and financial documentation. Patient must have no prescription drug coverage for the medication. Patient applications are evaluated on a case-by-case basis by the program.
Other Information:
Hours of operation: Monday-Friday 7:30am - 5:30pm CST
Product(s) covered by program:
  • Aggrenox® Capsules
  • Atrovent® Inhalation Aerosol
  • Combivent® Inhalation Aerosol
  • Micardis® HCT Tablets
  • Micardis® Tablets
  • Mirapex® Extended Release Tablets
  • Mirapex® Tablets
  • Spiriva® HandiHaler®
  • Twynsta® Tablets