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McNeil Consumer and Specialty Pharmaceuticals PAP
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McNeil Consumer and Specialty Pharmaceuticals PAP
PO Box 1015
San Bruno, CA 94066
Phone
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(866) 727-4626
Fax:
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Eligibility
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Eligibility is based on income and lack of third party prescription coverage. |
| Who Can Apply
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Physician's office must apply on patient's behalf. |
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Required
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A completed application with the physician's original signature and patient's income documentation are required. |
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Supply
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Flexeril is provided in a 90 day supply. For patients on Concerta, a six month supply of coupons is provided, each good for a thirty day prescription. |
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Ship To
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Physician's office or patient's home. |
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Note
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Physician must certify medical need. Income and insurance (indicating no prescription coverage) documentation must accompany application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Concerta XR Tablets |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
| Download printable Form Application Form |
(Requires Acrobat Reader) 
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