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Patient Assistance Information

 
Program Sponsored By Avanir Pharmaceuticals (External Link)
 
 
Avanir Patient Services (Hub)

PO Box 42886
Cincinnati, OH 45242
Phone : (855)468-3339
Fax: (877)788-4943
Eligibility
> Patient must be a U.S. citizen or legal resident ineligible for prescription drug assistance through Medicaid, Medicare, or Medicare Part D. Patients who are eligible for any state or federal government program, including Part D, are not eligible for this program. Patient must meet established financial criteria, must not have any private prescription drug coverage and have an income at or below 200% of the Federal Poverty Level (based on patient state of residence), adjusted for family size. The medication must be for FDA-approved use and within label guidelines. Applications are evaluated on a case-by-case basis.
Who Can Apply
> Anyone requesting assistance can call (855) 468-3339 to request a faxed application or download it from the website. Healthcare providers and their staff members, and Patients/Caregivers can initiate the application process online by visiting www.NuedextaSupport.com.
Required
> The physician (or other healthcare provider with prescriptive authority) must fill out their section of the application and sign and attach a prescription. The patient must fill out their section of the application, sign and attach proof of income. A new application with financial documentation and a new prescription is required every 6 months for continued participation in the program.
Supply
> A 3 month supply is provided.
Ship To
> The medication is shipped to the healthcare provider’s office.
Note
> Program is subject to change without notice or may be discontinued at any time without notice. A new application with financial documentation and a new prescription is required every 6 months for continued participation in the program.
 
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.
 
NUEDEXTA Capsules
ONZETRA™ Xsail™