PRESCRIPTION ASSISTANCE (I-P)
| Insomnia/Sleep Disorders AMBIEN (ZOLPIDEM) Sanofi Aventis (866)851-2826 WWW.ASTRAZENECA.COM Dalmane (flurazepam) Valeant (800) 331-1002 http://www.scbn.org/newForm/appA.php Halcion (triazolam) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Lunesta (eszopiclone) Sepracor (866) 418-9826 https://www.rxhope.com/papinfo.com Prosom (Estazolam) Abbott (800)633-9110 http://www.freemedicineprogram.org/application_form.html Restoril (Temazepam) Mallinckrodt (800)259-7765, opt 2 http://www.needymeds.com/papforms/mallin0247.pdf ROZEREM (RAMELTEON) TAKEDA PHARM. (800)830-9159 WWW.TPNA.COM Sonata ( Zaleplon) King Pharm. (800)331-1002 http://www.scbn.org/newForm/appA.php Low Blood Pressure Proamatine (Midodrine HCL) Shire (866)325 8224 http://www.shire.com/shire/Products/products.jsp?country=us Low Potassium K-Dur (potassium Chloride) Schering (888)477-2669 http://www.freemedicineprogram.org/application_form.html KLOR-CON UPSHER-SMITH (866) 851-2826 WWW.TOGETHERRXACCESS.COM Klotrix (potassium Chloride) Bristol Meyers Squibb (800)736-0003 http://www.cm-crmc.com/BMS-Plavix-Meds.pdf K-TAB (POTASSIUM CHLORIDE) ABBOTT (866)851-2826 WWW.TOGETHERRXACCESS.COM Micro-K (Potassium) KV Pharm.(800) 921-0072 http://www.freemedicineprogram.org/application_form.html Multiple Sclerosis AVONEX (POWDER OR INJECTION) BIOGEN IDEC (800)456-2255 WWW.RXASSIST.ORG Betaseron (Interferon) Berlex (877)836-5724 http://www.needymeds.com/papforms/betase0112.pdf Copaxone (Glatiramer Acetate) Teva Neurosciense (800)887-8100 http://www.rxhelp360.org/free-prescription-tools/pre-qualification-calculator.php Intron A (Interferon) Schering (800)521-7157 http://www.sch-plough.com/pdf/commitapp.pdf Rebif (Interferon Beta) EMD Serono (888)477-2669 http://www.pfizerhelpfulanswers.com/pages/find/findresult.aspx Tysabri (Natalizumab) Biogen Idec (800)456-2255 No Website Available Muscle Spasm Baclofen (Lioresal) Novartis (800)257-3273 http://www.freemedicineprogram.org/application_form.html Dantrium (Dantrolene) Proctor and Gamble (888)477-2669 https://www.pparx.org/PreQual.php Equgesic (Meprobamate + Aspirin) Wyeth-Ayerst Labs (800)424-3727 FLEXERIL (CYCLOBENZAPRINE) XUBEX PHARM (866)699-8239 WWW.XUBEX.COM Mestinon (Cholinesterase) Valeant (800)511-2120 http://www.rxassist.org/Register/Patient_Reg.cfm Norflex (Orphenadrine) Graceway (866)628-6498 Skelaxin (Metaxalone) King Pharm (866)734 7366 http://www.needymeds.com/papforms/kingka0225.pdf Soma (Carisoprodol) MedPointe No Assistance Program Available ZANAFLEX (TIZANIDINE) ACORDA THER. (800)464-0097 WWW.TOGETHERRXACCESS.COM Narcolepsy Dextrostat (Dextroamphetamine) Shire No Assistance program Available Focalin XR (Dexmethylphenidate) Novartis PROVIGIL (MODAFINIL) CEPHALON INC. (800)675-8415 WWW.PPARX.ORG Nausea/Vomiting Aloxi (Palonosetron) MGI Pharma (877)644-6270. http://www.aloxi.com/channels/3.asp?id=48 Antivert (Meclizine) Pfizer (704)536-1790 http://medassist.org/content/page/id/10 Anzement (Dolasetron Mesylate) Sanofi Aventis (888)477-2669 http://www.sanofi-aventis.us/live/us/en/layout.jsp?cnt=34FFDF5A-E281-466F-BDCE-2658D8 763A11 Cesamet (Nabilone) Valeant (800)593-6910 http://www.doh.state.fl.us/mqa/DDC/Cancer/Forms/ap_Valent.pdf Compazine (Prochlorperazine) GlaxoSmithKline (800)546-0420 http://www.freemedicineprogram.org/application_form.html Emend (Aprepitant) Merck (866)363-6379 http://www.emend.com/emend/shared/documents/enrollment_form.pdf Kytril (Granisetron) Roche (800)443-6676 http://www.kytril.com/patients/cp-assistance.asp Marinol (Dronabinol) Unimed (800)256-8918 http://www.atdn.org/access/pa/dron.html Reglan (Metoclopramide) Schwartz Pharma. (800)558-5114 http://www.pfizerhelpfulanswers.com/pages/find/find.aspx Thorazine (Chlorpromazine HCL) GlaxoSmithKline (800)546-0420 http://www.freemedicineprogram.org/application_form.html Tigan (Trimethobenzamide HCL) King Pharm Unavalable ZOFRAN (ONDANSETRON) XUBEX PHARM (866)699-8239 WWW.XUBEX.COM Neuropathy LYRICA (PREGABALIN) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Nutritional Drinks ENSURE NUTRITIONAL DRINK ABBOTT/ROSS (800)222-6885 OPT.5 WWW.TOGETHERRXACCESS.COM GLUCERNA SELECT DRINK ABBOTT /ROSS (800)222-6885 OPT.5 WWW.PPARX.ORG Osteoporosis Actonel (Risedronate) Procter And Gamble (800)830-9049 http://www.needymeds.com/papforms/procte0136.pdf BONIVA (IBANDRONATE) ROCHE PHARM. (888)587-9438 WWW.PPARX.ORG Didronel (Etidronate Disodium) Procter And Gamble (800)830-9049 http://www.needymeds.com/papforms/procte0136.pdf Evista (Raloxifene) Lilly Pharm. (800)545-6962 http://www.lillycares.com/pdf/lilly_cares_application.pdf Forteo (Teriparitide) Lilly Pharm. (800)545-6962 http://www.lillycares.com/pdf/lilly_cares_application.pdf Fortical (Calcitonin Salmon) Upsher-Smith No Assistance Program Available Fosamax (Alendronate) Merck (800)994-2111 http://www.fosamax.com/fosamax/shared/documents/english_enrollment.pdf Miacalcin (Calcitonin) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_enrollment_application.pdf Overactive Bladder Cardura (Doxazosin) Pfizer (866)776-3700 https://www.pfizerhelpfulanswers.com/files/C2C_English.pdf DDAVP (Desmopressin) Sanofi Aventis (800)221-4025, opt 2 http://togetherrxaccess.com/home.html DETROL LA (TOLTERODINE) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Enablex (Darifenacin) Novartis (401)729-3284 http://www.rxassist.org/Register/Patient_Reg.cfm Flomax (Tamsulosin) Boehringer Ingelheim (800)556-8317 http://us.boehringer-ingelheim.com/resources/pdf/philanthropy/PAP_Form.pdf Hytrin (terazosin) Abbott (800)921-0072 http://www.freemedicineprogram.org/form.pdf OXYBUTYNIN (DITROPAN) UPSHER-SMITH (866)851-2826 http://www.rxassist.org/Register/Patient_Reg.cfm Oxytrol Patch (Oxybutynin) Watson (800)964-4766 http://www.rxassist.org/Register/Patient_Reg.cfm Tofranil (Imipramine hcl) Mallinckrodt (800)259-7765, opt 2 http://www.needymeds.com/papforms/mallin0247.pdf Uroxatral (Alfuzosin) Sanofi Aventis (800)221-4025, opt 2 http://www.needymeds.com/papforms/sanofi0150.pdf Vesicare (Solifenacin) Astellas (401)729-3284 http://www.rxassist.org/Register/Patient_Reg.cfm Pain Medication Anaprox (Naproxen) Roche (800)769-3880 http://www.rxoutreach.com/en/PDF/PatientAppEC6020907.pdf Avinza (Morphine Sulfate) King Pharm. (800)966-0407 http://togetherrxaccess.com/home.html Balacet (Propoxyphene) Cornerstone No Assistance Program Available Combunox (Oxycodone) Forest (800)851-0728 www.forestpharm.com/PAP Carbatrol (Carbamazepine) Shire (866)325-8224 http://www.carbatrol.com/Patients/Resources/PatientAssistance.aspx Cataflam (Diclofenac) Novartis (800)546-0420 http://www.freemedicineprogram.org/application_form.html Celebrex (Celecoxib) Pzifer (866)706-2400 http://www.pfizerhelpfulanswers.com/files/C2C_English.pdf Cymbalta (duloxetine) Lilly (800)545-6962 http://www.lillycares.com/pdf/lilly_cares_application.pdf Darvocet-n 50 (Propoxyphene) Xanodyne (800)921-0072 http://www.freemedicineprogram.org/application_form.html Demerol (Meperidine) Sanofi Aventis http://sdrxcard.com/pap.php Dilaudid (Hydromorphone) Abbott (800)921-0072 http://www.freemedicineprogram.org/application_form.html Dolobid (Difunisal) Merck (800)999-1796 http://www.merck.com/merckhelps/patientassistance/application.html Duragesic (Fentanyl) Janssen (800)652-6227 http://www.atdn.org/access/pa/fent.html FENTORA (FENTANYL BUCCAL) CEPHALON INC. (877)433-6867 WWW.PPARX.ORG KADIAN C-II (MORPHINE SULF.) ALPHARMA PHARM. (888)206-9743 WWW.NEEDYMEDS.COM Lidoderm Patch (Lidocaine) Endo (401)729-3284 http://www.rxassist.org/Register/Patient_Reg.cfm Lodine (Etodolac) Wyeth (866)699-8239 https://secure.xubex.com/apply/ Lyrica (Pregabalin) Pfizer (866)776-3700 https://www.pfizerhelpfulanswers.com/files/C2C_English.pdf MS Contin (Morphine Sulfate) Purdue Pharma. (800)599-6070 WWW.RXASSIST.ORG Nalfon (Fenoprofen) Pedinol No Assistance Program Available Naprelan (Naproxen) Victory Pharma. (800)847-7147 http://rxvouchers.com/voucher.html?id=020353 Norco 5/325 (Hydrocodone+Acetaminophen) Watson (800)921-0072 http://www.freemedicineprogram.org/form.pdf Nubain (Nalbuphine Hcl) Endo Pharm. No Assistance Program Available OXYCONTIN (OXYCODONE) PURDUE PHARM. (800)599-6070 WWW.RXASSIST.ORG Percocet (Oxycodone+Acetaminophen) Endo (800)474-2762 http://www.freemedicineprogram.org/form.pdf Percodan (Oxycodone HCL+Aspirin) Endo. No Assistance program Available Roxicet (Oxycodone+Acetaminophen) Roxane (800)474-2762 http://www.freemedicineprogram.org/form.pdf Talacen (Pentazocine+Acetaminophen) Sanofi Aventis (800)847-7147 http://rxvouchers.com/voucher.html?id=018458 Tegretol (Carbamazepine) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_enrollment_application.pdf Tylenol w.Codeine (Codeine) Ortho-Mcneil. No Assistance Program Available ULTRACET (ACETAMINOPHEN) JOHNSON&JOHNSON (800)652-6227 WWW.JNJ.COM Vicoden (Hydrocodone) Abbott (800)474-2762 http://www.freemedicineprogram.org/form.pdf Xodol (hydrocodone) Victory Pharma. No Assistance program Available Zydone (Hydrocodone Bitartrate) Endo. (800)474-2762 http://www.freemedicineprogram.org/form.pdf |
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