Â鶹¹ú²úAV

How to Apply

The Â鶹¹ú²úAV Patient Assistance Program provides certain medicines for free to patients with a demonstrated financial need. To determine if you may be eligible, select your medicine from the menu below and follow the instructions shown on the application. If you have questions or need additional support, please call the customer service number listed below for your medicine.

Â鶹¹ú²úAV Patient Assistance Program Medicines

Select your medicine from the drop down menu.

Â鶹¹ú²úAV Patient Assistance Program Product Groups

For support, please contact the customer service number for your medicine.

 

Group 1 Medicines: Group 2 Medicines:
Phone: 888-417-5780 Phone: 888-417-5782
Fax: 877-427-7290 Fax: 866-792-7945

Â鶹¹ú²úAV

Group One Medicines
Arixtra® Gastrocrom®
Breyna® Miacalcin®
Clozapine® Perforomist®
Cortifoam® Pretomanid®
Cystagon® Proctofoam HC®
Denavir® Rowasa®
Dipentum® SF Rowasa®
Dymista® Wixela®
Emsam® Xulane®
Ermeza® Yupelri®
Felbatol®
Group Two Medicines
Caduet®
Epinephrine Injection
Glatiramer Acetate
Relpax®
Tobi® Products