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Patient Assistance Information

 
Program Sponsored By Impax Laboratories Inc. (External Link)
 
 
Impax Patient Assistance Program

PO Box 66554
St. Louis, MO 63166
Phone : 877-764-9021
Fax: 877-764-9022
Eligibility
> The Impax Patient Assistance Program provides brand name medications at no or low cost and is intended for patients that are uninsured or underinsured. Eligibility for patients with Medicare Part D will be determined on a case by case basis. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> Patients and doctors can apply by calling or downloading the application.
Required
> Patients and physician's must complete and sign the application. Proof of income must be faxed along with the application. Patient and physicians will be notified by mail withing 7-10 days.
Supply
> Supply varies.
Ship To
> Medication will be shipped to the patients home within 7-10 days.
Note
> Those with Medicare Part D must have spent at least 3% of annual household income out-of-pocket on prescription medicines. Contact program for Spanish 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.
 
Rytary capsule; extended release
Zomig Nasal Spray
Zomig Tablets
Zomig-ZMT Orally Disintegrating Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader