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Patient Assistance Information

 
1 Program for EMSAM transdermal
 
 
Mylan EMSAM Transdermal System Patient Assistance Program (MEPAP)

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
> Up to 90 day supply
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