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Impax Patient Assistance Program
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PO Box 66554
St. Louis, MO 63166
Phone
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877-764-9021
Fax:
877-764-9022
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Eligibility
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The Impax Patient Assistance Program provides brand name medications at no or low cost and is intended for patients that are uninsured or underinsured. Eligibility for patients with Medicare Part D will be determined on a case by case basis. Income requirements for this program have not been disclosed. Patients must be a US resident. |
| Who Can Apply
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Patients and doctors can apply by calling or downloading the application. |
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Required
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Patients and physician's must complete and sign the application. Proof of income must be faxed along with the application. Patient and physicians will be notified by mail withing 7-10 days. |
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Supply
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Supply varies. |
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Ship To
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Medication will be shipped to the patients home within 7-10 days. |
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Note
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Those with Medicare Part D must have spent at least 3% of annual household income out-of-pocket on prescription medicines.
Contact program for Spanish application. |
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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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| Rytary capsule; extended release |
| Zomig Nasal Spray |
| Zomig Tablets |
| Zomig-ZMT Orally Disintegrating Tablets |
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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 |
(Requires Acrobat Reader) 
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