| |
Ampyra Patient Assistance Program
|
,
Phone
:
(888)881-1918
Fax:
(888)883-3053
|
|
Eligibility
|
| > |
Applicants must be US citizen or legal resident and have a diagnosis of MS. Applicants with Medicare Part D may be eligible. Those with insurance may be eligible but are considered on a case by case basis. |
| Who Can Apply
|
| > |
Anyone may call to request an application. It will be mailed to the applicants home and must be returned via fax. |
|
Required
|
| > |
The program will notify the applicant of what is required. |
|
Supply
|
| > |
If approved a 30 or 90 day supply will be provided. |
|
Ship To
|
| > |
It will be shipped to the patient's address. To obtain a refill the patient must contact the pharmacy. |
|
Note
|
| > |
|
| |
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.
|
| Ampyra |
| |
| |
|
|