# Boehringer Cares Patient Assistance Program  How to apply:

### Application Options

Option 1:

#### Online enrollment (Healthcare Provider only)

Now you can make enrolling easier with the new online application process:

[Begin online enrollment application](/content/us/disclaimer/external?path=https%3A%2F%2Fboehringercares.rxlightning.com%20/index.html)

Option 2:

#### Print and mail or fax

1. **Download and complete enrollment application form:**

[English enrollment application](/content/us/pdf/boehringer-cares-patient-assistance-program-application-englishpdf/index.html)

2. **Mail or fax enrollment application form to:**

Boehringer Cares Patient Assistance Program

PO Box 99055

Jeffersontown, KY 40296

Fax: 1-866-851-2827

### Refills

Are you already enrolled in our program?

[If yes, order your refill medication here](/content/us/disclaimer/external?path=https%3A%2F%2Ffillmyrefills.com%2FKnipperx%2FOrderRefills.aspx).

## Services

### Patient Assistance Program

The Boehringer Cares Patient Assistance Program is a charitable program provided by the Boehringer Ingelheim Cares Foundation (Boehringer Cares), an independent nonprofit organization, to improve patients’ health and lives.

Read more

### References