Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
1 Program for EpiPen 2-Pak injection
 
 
Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

781 Chestnut Ridge Road
Morgnatown, WV 26505
Phone : (800)395-3376
Fax: (304)554-4713
Eligibility
> 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
> Anyone interested can obtain an application by calling and it can be faxed, emailed or mailed to them.
Required
> 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.
Supply
> Varies
Ship To
> Doctor's office
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.
 
EpiPen 2-Pak injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader