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Pernix Therapeutics Patient Assistance Program
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PO Box 32444
Charlotte, NC 28232
Phone
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(800)340-3042
Fax:
(919)882-1659
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients must be at or below 250% of the federal poverty level. The medication must be medically necessary for the patient as determined by a doctor. The patient must reside permanently in the US or a US territory. |
| Who Can Apply
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Patient or healthcare providers can call to have an application faxed, it can be downloaded or they can apply online. |
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Required
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Patients must complete a section, sign and attach required documents. Doctors must complete a section, sign, and fax a prescription form their office. |
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Supply
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90 day supply |
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Ship To
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Patient's home |
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Note
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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.
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| Treximet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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