Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Advanced Patient Services (APS) Program

This program provides brand name medications at no or low cost

Provided by: Avanir Pharmaceuticals, Inc.

PO Box 42886
Cincinnati, OH 45242

TEL: 855-468-3339


FAX: 877-788-4943
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Avanir Patient Services (APS) Enrollment Form

Avanir Brochure for Nuedexta

Avanir Brochure for Onzetra Xsail

 

Brand Name Medications Covered

 
  • Nuedexta
  • Onzetra Xsail
 

Generic Name

 
  • dextromethorpan hydrobromide/quinidine
  • sumatriptan
 

Eligibility Requirements   

Insurance Status Must not have any insurance or be eligible for state or federal funded healthcare
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 30 day supply
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

This program also provides co-pay and reimbursement assistance.

Please visit www.Nuedexta.com & www.Onzetra.com for more information.


Updated June 01, 2017