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


Donnatal Patient Assistance Program

Provided by: Concordia Healthcare USA Inc.

Attn: RxOutReach
PO Box 66536
St. Louis, MO 63166-6536

TEL: 877-318-9544

ALT PHONE: 800-769-3880
FAX: 800-875-6591
Languages Spoken:


Program Website


Program Applications and Forms

Donnatal Patient Assistance Program Application, offered by RxOutreach



  • Donnatal tablet (phenobarbital/hyoscyamine sulfate/atropine sulfate/scopolamine HBr)

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US


Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day


Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly

Additional Information

Updated June 01, 2015