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Mylan EMSAM Transdermal System Patient Assistance Program (MEPAP)
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781 Chestnut Ridge Road
Morgantown, WV 26505
Phone
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(800)395-3376
Fax:
(304)554-4713
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Eligibility
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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. The medication must be deemed medically necessary by a doctor and patients must be a US citizen or legal resident. |
| Who Can Apply
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Anyone interested can call to have an application faxed, mailed or emailed. |
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Required
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Doctors must complete and sign a section of the application. Patients must also complete and sign a section of the application. They must also attach proof of income and proof of lack of drug coverage. |
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Supply
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Up to 90 day supply |
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Ship To
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Doctor's office |
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Note
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This program also provides copay assistance. |
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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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| EMSAM transdermal |
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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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