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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program
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781 Chestnut Ridge Road
Morgnatown, WV 26505
Phone
:
(800)395-3376
Fax:
(304)554-4713
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients must be at or below 200% of the federal poverty level. The medication must be medically necessary as determined by a doctor and must be a US citizen or legal resident. |
| Who Can Apply
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Anyone interested can obtain an application by calling and it can be faxed, emailed or mailed to them. |
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Required
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Doctors must complete a section, sign, and attach a prescription. Patients must complete a section, sign, attach proof of income, and attach proof of lack of drug coverage. |
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Supply
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Varies |
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Ship To
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Doctor's office |
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Note
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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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| EpiPen 2-Pak injection |
| EpiPen Jr 2-Pak injection |
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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 |
(Requires Acrobat Reader) 
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Mylan EMSAM Transdermal System Patient Assistance Program (MEPAP)
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781 Chestnut Ridge Road
Morgantown, WV 26505
Phone
:
(800)395-3376
Fax:
(304)554-4713
|
|
Eligibility
|
| > |
This program provides brand name medications at no or low cost for patients that have no prescription coverage. Patients must be at or below 200% of the federal poverty level. The medication must be deemed medically necessary by a doctor and patients must be a US citizen or legal resident. |
| Who Can Apply
|
| > |
Anyone interested can call to have an application faxed, mailed or emailed. |
|
Required
|
| > |
Doctors must complete and sign a section of the application. Patients must also complete and sign a section of the application. They must also attach proof of income and proof of lack of drug coverage. |
|
Supply
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| > |
Up to 90 day supply |
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Ship To
|
| > |
Doctor's office |
|
Note
|
| > |
This program also provides copay assistance. |
| |
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.
|
| EMSAM transdermal |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| (Requires Acrobat Reader)
|
| |
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