Registered Users Log-in:

E-mail Address:


Forgot Password?
Patient Assistance Information

Program Sponsored By Actavis (External Link)
Gelnique Patient Assistance Program

PO Box 1265
San Bruno, CA 94066
Phone : (855)217-1616
Fax: (855)888-7210
> Patients must have no prescription coverage for the needed medication. They must have an FDA-approved diagnosis and be a US citizen or legal resident. Patients with Medicare Part D may be eligible if the medication is not covered.
Who Can Apply
> Patients or healthcare providers must call to obtain an application.
> Patients and healthcare providers must complete and sign a section of the application.
> A 90 day supply will be provided.
Ship To
> The medication is shipped to the healthcare providers office.
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.
Gelnique Gel 3%, 10% (oxybutynin chloride)