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Patient Assistance Information

 
 
 
Ampyra Patient Assistance Program


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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