PRESCRIPTION ASSISTANCE (P-W)
| Parkinson's Apokyn (Apomorphine) Vernalis (888)477-2669 www.pparx.com Azilect (Rasagiline) Teva. (866)217-7163 http://www.needymeds.com/papforms/azilec1125.pdf Comtan (Entacapone) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_enrollment_application.pdf Eldepryl (Selegiline) Somerset (888)477-2669 https://www.pparx.org/PreQual.php Exelon (Rivastigmine) Novartis (800)277-2254 http://www.amgen.com/patients/assistance.html Parcopa (Carbidopa) Schwarz Pharma (800)477-7877, opt 7, opt 1 http://www.needymeds.com/papforms/parcop0327.pdf Parlodel (Bromocriptine) Novartis (800)865-7211 http://www.togetherrxaccess.com/home.html Requip (Ropinirole) GlaxoSmithKline (800)921-0072 http://www.freemedicineprogram.org/application_form.html Sinemet (Carbidopa) Bristol-Myers Squibb (800)921-0072 https://www.rxhope.com/papinfo/company/pdf/bristol_pap.pdf Stalevo (Levodopa) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_enrollment_application.pdf Tasmar (Tolcapone) Valeant (800)511-2120 http://www.doh.state.fl.us/mqa/DDC/Cancer/Forms/ap_Valent.pdf Zelapar (Phenylalanidne) Valeant (800)511-2120 http://www.doh.state.fl.us/mqa/DDC/Cancer/Forms/ap_Valent.pdf Pressure Ulcers Granulex (Trypsin) Bertek (888)823-7835 Psoriasis Amevive (Alefacept) Astellas (866)263-8483 http://www.amevive.com/pdf/AMEVIVE_ASAP_enrollment_form.pdf Dovonex (Calcipotriene) Warner Pharm. (800)511-2120 https://www.rxhope.com/papinfo/company/pdf/bristol_pap.pdf Enbrel (Etanercept) Amgen (888)436-2735 http://www.enbrel.com/ra/insurance-help.jsp Neoral (Cyclosporine) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_cns_enroll.jsp Remicade (Infliximab) Centocor (866)489-5957 http://www.needymeds.com/papforms/remica0192.pdf Soriatane (Acitretin) Stiefel (800)572-3225 ext 2234 http://www.needymeds.com/papforms/stiefe0328.pdf Tazorac (Tazarotene) Allergan (800)553-6783 http://www.needymeds.com/papforms/allerg0004.pdf Psychosis HALOPERIDOL (HALDOL) UPSHER-SMITH (866)851-2826 http://www.atdn.org/access/pa/tram.html Seizures DEPAKOTE ABBOTT (866)851-2826 WWW.TOGETHERRXACCESS.COM DILANTIN (PHENYTOIN) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Felbatol (Felbamate) MedPointe 800-678-4657 http://www.needymeds.com/papforms/medpoi0047.pdf GABAPENTIN (NEURONTIN) XUBEX PHARM (866)699-8239 WWW.XUBEX.COM Gabitril (Tiagabine) Cephalon (800)511-2120 http://www.aesnet.org/visitors/PatientsPractice/PDAPs/dsp_content.cfm?drugid= 6 Klonopin (Clonazepam) Roche (877)757-6243 https://www.pparx.org/PreQual.php KEPRA (Levetiracetam) UCB (800)477-7877 OPT. 1 WWW.RXASSIST.ORG Lamictal (Lamotrigine) GlaxoSmithKline (866)728-4368) http://www.bridgestoaccess.com/PatientEnrollment?pageFunction=FORMPATIE NT Lyrica (PREGABALIN) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Mysoline (Primidone) Valeant (800)511-2120 http://www.aesnet.org/visitors/PatientsPractice/PDAPs/dsp_content.cfm?drugid= 10 Neurontin (Gabapentin) Pfizer (800)707-8990 http://www.aesnet.org/visitors/PatientsPractice/PDAPs/dsp_content.cfm?drugid= 19 Phenytek (Phenytoin) Bertek (888)823-7835 http://www.efwp.org/programs/pap_list.shtml TEGRETOL XR (CARBAMAZEPINE) NOVARTIS (800)277-2254 WWW.PHARMA.US.NOVARTIS.COM Topamax (Topiramate) Ortho-Mcneil (800)577-3788 http://www.atdn.org/access/pa/tram.html Trileptal (Oxcarbazepine) Novartis (800)277-2254 http://www.pharma.us.novartis.com/novartis/pap/pap_other_products_enroll.jsp Valium (Diazepam) Roche (866)699-8239 HTTP://WWW.XUBEX.COM Smoking CHANTIX (VARENICLINE) PFIZER, INC. (866)906-2800 WWW.PFIZERHELPFULANSWERS.COM Commit Lozenge GlaxoSmithKline (800)477-2669 https://www.pparx.org/SelectMedication.php Nicoderm CQ (Nicotine) GlaxoSmithKline (800)722-9294 No Assistance Program Available Nicotrol (Nictone) Pfizer (800)707-8990 http://www.needymeds.com/papforms/pficon0133.pdf Zyban (Bupropion) GlazoSmithKline No Assistance Program Available Thyroid LEVOTHROID (LEVOTHYROXINE) FOREST PHARM. (800)851-0758 WWW.FORESTPHARM.COM/PAP LEVOTHYROXINE (SYNTHROID) UPSHER-SMITH (866)851-2826 WWW.RXHOPE.COM Urinary Retention Avodart (Dutasteride) GlaxoSmithKline (866)728-4368 http://www.bridgestoaccess.com/PatientEnrollment?pageFunction=FORMPATIE NT Proscar (Finasteride) Merck (800)999-1796 http://www.merck.com/merckhelps/patientassistance/application.html Urecholine (Bethanechol) Odyssey Pharm. No Assistance Program Available Warts Aldara (Imiquimod) Graceway Pharm. (800)328-0255 http://www.3m.com/us/healthcare/pharma/PatientAssistance.pdf Condylox (Podofilox) Oclassen (800)921-0072 http://www.freemedicineprogram.org/application_form.html Water Pill Aldactazide 25 (Spironolactone+hctz) Pfizer (866)776-3700 https://www.pparx.org/PreQual.php Aldactone (Spironolactone) Pfizer (866)776-3700 http://www.pfizerhelpfulanswers.com/pages/find/findresult.aspx BUMEX (BUMETANIDE) XUBEX PHARM (866)699-8239 WWW.XUBEX.COM Demadex (Torsemide) Roche (866)699-8239 https://secure.xubex.com/apply/ Diuril (Chlorothiazide) Merck (800)994-2111 http://www.atdn.org/access/pa/timo.html Dyazide (Triamterene) GlaxoSmithKline (888)672-6436 https://www.rxhope.com/papinfo/company/pap_list_bydrug.asp HYDROCHLOROTHIAZIDE UPSHER-SMITH (866)851-2826 http://www.azandme.com/making/mak_pap.aspx#medicine_list Hydrodiuril (Hydrochlorothiazide) Merck (732)507-7400 https://www.rxhope.com/papinfo/pap_advanced_search.asp?filter LASIX (FUROSIMIDE) XUBEX PHARM (866)699-8239 WWW.XUBEX.COM Maxzide (Triamterene) Bertek (800)921-0072 http://www.freemedicineprogram.org/application_form.html Midamor (Amiloride) Merck (800)999-1796 http://www.atdn.org/access/pa/timo.html Moduretic (Amiloride+Hctz) Merck (800)999-1796 http://www.atdn.org/access/pa/timo.html Zaroxolyn (Metolazone) UCB (866)523-3994 http://www.seniormag.com/free-medication/celltech.htm |
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