Program Applications M
Tips for using the applications:
- You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
- Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
- Use the "tab" key to easily go to the next field.
As of 03/10/2014 there are 626 applications available.
Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.
Send the completed application to the address on the application and not to NeedyMeds.
If you cannot find an application or are having trouble printing one, contact the program or company.
Makena Referral/Prescription Form 01/29/14
Marathon Patient Assistance Program: Contact program
Matri-Stem Reimbursement: Contact program
Matulane Patient Assistance Program: Contact program
Meda Pharamaceuticals Patient Assistance Program 02/21/14
Medical Foods Free Sample Program for Healthcare Providers: Contact program
MedImmune Assistance Program (MAP): Contact program
Merck Co-Pay Assistance Program: Contact program
Merck PAP Application for Invanz, Primaxin, and Cancidas 12/03/13
Merck Patient Assistance Program 01/23/14
Merck Patient Assitance Program (Spanish) 01/23/14
Merck Vaccine Patient Assistance Program 01/10/14
Merck Vaccine Patient Assistance Program (Spanish) 01/10/14
Millennium Reimbursement Assistance for Velcade 01/14/14
Mission Pharmaceutical Patient Assistance Program: Contact program
Mission Product Request: Contact program
MS Lifelines for Insured Patients with No Rx Coverage: Contact program
MS Lifelines for Patients with a Drug Cap: Contact program
MS Lifelines for Patients with a High Co-Pay: Contact program
MS Lifelines for Patients with Medicare Part D: Contact program
MS Lifelines for Uninsured Patients: Contact program
MS One to One Start Form 02/21/14
MuGard Prescription Form 09/20/13
My Brisdelle: Contact program
My PN Support Program 09/06/13
Mylan Patient Assistance Program 02/11/14
Myobloc PAP Enrollment Form 01/20/14
Myobloc Reimbursement Enrollment Form 01/20/14