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Patient Assistance Information

Pernix Therapeutics Patient Assistance Program

PO Box 32444
Charlotte, NC 28232
Phone : (800)340-3042
Fax: (919)882-1659
> This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients must be at or below 250% of the federal poverty level. The medication must be medically necessary for the patient as determined by a doctor. The patient must reside permanently in the US or a US territory.
Who Can Apply
> Patient or healthcare providers can call to have an application faxed, it can be downloaded or they can apply online.
> Patients must complete a section, sign and attach required documents. Doctors must complete a section, sign, and fax a prescription form their office.
> 90 day supply
Ship To
> Patient's home
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.
Silenor tablet
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
(Requires Acrobat Reader