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Sunovion Support Prescription Assistance Program (Aptiom)
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PO Box 220285
Charlotte, NC 28222
Phone
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(877)850-0819
Fax:
877-850-0821
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Eligibility
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Patients must have no prescription coverage for the needed medication, be at or below 300% of the Federal Poverty Level, must reside in the US, Puerto Rico or USVI and must provide a diagnosis code. |
| Who Can Apply
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Patients or healthcare providers can call to have an application mailed or it can be downloaded. |
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Required
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Doctors must complete a section of the application and sign. Patients must also complete a section of the application, sign and attach proof of income. |
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Supply
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30 day supply |
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Ship To
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Pharmacy |
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Note
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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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| Aptiom tablet |
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