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Patient Assistance Information

 
 
 
MEDA Patient Assistance Program

PO Box 42886
Cincinnati, OH 45242
Phone : (800) 593-7923
Fax: (513)618-0053
Eligibility
> The Patient Assistance Program provides assistance to patients that cannot afford their medication and have no form of drug coverage. Annual household income limits do apply but each case is reviewed on an individual basis. Patients must reside in the U.S. and be under the care of a U.S. based physician.
Who Can Apply
> The physician's office may apply on the patient's behalf or patients can also initiate the application process online.
Required
> Physician may complete the application online, sign, and fax the request form attesting to the need of the patient. Physician's state license number is required to process the application.
Supply
> For Felbatol, a 90 day supply is sent.
Ship To
> All medication will be shipped to the physician’s office.
Note
> Please attach Proof of Income with your application.
 
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.
 
Felbatol (felbamate)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
OTH11040