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Patient Assistance Information

Program Sponsored By Ortho McNeil (External Link)
McNeil Consumer and Specialty Pharmaceuticals PAP

McNeil Consumer and Specialty Pharmaceuticals PAP
PO Box 1015
San Bruno, CA 94066
Phone : (866) 727-4626
> Eligibility is based on income and lack of third party prescription coverage.
Who Can Apply
> Physician's office must apply on patient's behalf.
> A completed application with the physician's original signature and patient's income documentation are required.
> 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.
Ship To
> Physician's office or patient's home.
> Physician must certify medical need. Income and insurance (indicating no prescription coverage) documentation must accompany application.
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.
Concerta XR Tablets
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Application Form
Download printable Form Application Form
(Requires Acrobat Reader