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Patient Assistance Information

 
1 Program for Episil Concentrated Oral Liquid
 
 
Episil Patient Assistance Program


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Phone : (855)437-4745 Ext 5
Fax: (973)656-2626
Eligibility
> Patients must have no prescription insurance for the requested medication, including Medicare Part D. Patients must have an income at or below 300% of the Federal Poverty level and have a medically approved condition.
Who Can Apply
> Requestors can obtain an application by calling the program.
Required
> Patients must complete a section of the application and attachproof of income and any insurance information. The prescriber must also complete and sign the application.
Supply
> The supply/amount provided varies.
Ship To
> The supply will be sent to the healthcare provider or a pharmacy.
Note
>
 
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.
 
Episil Concentrated Oral Liquid