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Gabitril Patient Assistance Program
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c/o InTeleCenter
PO Box 4280
Gaithersburg, MD 20885-4280
Phone
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866-209-7589
Fax:
866-209-7596
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Eligibility
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The patient must be uninsured and have an income at or below 200% of the Federal Poverty Level. The patient must also be taking the medication for an on-label diagnosis.The patient must also be a US resident. |
| Who Can Apply
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The doctor/doctor's office must call for a prescreening. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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A coupon for 90-day supply |
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Ship To
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Note
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The doctor/doctor's office must call for a prescreening. |
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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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| Gabitril (tiagabine hydrochloride) |
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