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Supernus Patient Assistance Program
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c/o The Lash Group, Inc.
9717 Key West Avenue
Rockville, MD 20850
Phone
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866-398-0833
Fax:
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Eligibility
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Patients must be uninsured, meet income requirements that have not been disclosed and be a US resident. The medication must be medically necessary as determined by a doctor. |
| Who Can Apply
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Patients or healthcare providers can download the application. |
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Required
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Doctors and patients must each complete a section of the application and sign. |
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Supply
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Up to 1 month supply |
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Ship To
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Patient's home |
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Note
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This program also provides copay assistance.
www.oxtellarxr.com
www.trokendixrhcp.com |
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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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| topiramate capsule; extended release |
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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 |
| Download printable Form |
(Requires Acrobat Reader) 
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