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Patient Assistance Information

Gabitril Patient Assistance Program

c/o InTeleCenter
PO Box 4280
Gaithersburg, MD 20885-4280
Phone : 866-209-7589
Fax: 866-209-7596
> 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
> The doctor/doctor's office must call for a prescreening.
> 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.
> A coupon for 90-day supply
Ship To
> The doctor/doctor's office must call for a prescreening.
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.
Gabitril (tiagabine hydrochloride)