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Is your medicine listed on the formulary as having exception drug status or is it intended to be used for a reason that is not covered or is it not listed on the formulary?

Do you have a chronic disease or a functional disability?

Are you a child of a low-income family?

Are you older than 65 years old and do not have access to any other public or private prescription coverage programs?

Are you a patient receiving palliative care?

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Charitable Number: 80425 7814 RR 0001

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