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Patient Assistance Information

 
2 Programs for Flexeril Tablets
 
 
McNeil Consumer and Specialty Pharmaceuticals PAP

McNeil Consumer and Specialty Pharmaceuticals PAP
PO Box 1015
San Bruno, CA 94066
Phone : (866) 727-4626
Fax:
Eligibility
> Eligibility is based on income and lack of third party prescription coverage.
Who Can Apply
> Physician's office must apply on patient's behalf.
Required
> A completed application with the physician's original signature and patient's income documentation are required.
Supply
> Flexeril is provided in a 90 day supply. For patients on Concerta, a six month supply of coupons is provided, each good for a thirty day prescription.
Ship To
> Physician's office or patient's home.
Note
> Physician must certify medical need. Income and insurance (indicating no prescription coverage) documentation must accompany 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.
 
Flexeril Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Xubex Pharmaceutical Services

PO Box 1244
Winter Park, FL 32790-1244
Phone : 866-699-8239
Fax: 407-671-7960
Eligibility
> The patient must have an income at or below 243% of the Federal Poverty Level.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> The doctor needs to provide a prescription to the patient.The patient must fill out a section and sign the application.
Supply
>
Ship To
> Either Doctor's office or Patient's home
Note
> Anyone requesting assistance can call to request a faxed application or download it from the website.
 
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.
 
Flexeril Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader