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Patient Assistance Information

Mylan Miacalcin Injection Patient Assistance Program

PO Box 219
Gloucester, MA 01930
Phone : (888)238-5694
Fax: (888)246-6527
> This program provides brand name medications at no or low cost for patients that have no prescription coverage. Patients must be at or below 200% of the federal poverty level. Patients must also have a medically appropriate diagnosis and be a US citizen or legal resident.
Who Can Apply
> Anyone interested can call to have an application faxed or mailed and it can also be downloaded.
> The doctor must complete and sign a portion of the application. The patient must also complete and sign a portion of the application and attach required documents.
> Up to one month supply
Ship To
> Doctor's office
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.
Miacalcin Injection
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
(Requires Acrobat Reader