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Program 1 of 3 Scroll down to see them all.

This program provides generic medications at a discount.
Pharmaceutical Company Express Scripts Specialty Distribution Services
Program Name Rx Outreach Medications
Program Address PO Box 66536
St Louis, MO 63166-6536
Phone Number

800-769-3880
Fax Number
Medications on Program nortriptyline Capsules 10mg, 25mg, 50mg, 75mg (Pamelor)
Application Forms Rx Outreach
On-line Application
 No on-line application available at this time
Web Site Click to go to program's web site
Eligibility Guidelines and Notes

Applicants with insurance are eligible. have an income at or below 300% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This program is for generic medications only. Many medications are available for a fee of $20 for up to a 180 day supply. Prices vary for Tier 2 and Tier 3 medications. Please refer to the Rx Outreach website for more information.

Application Process

Anyone requesting assistance can call to request a faxed application or download it from the website. The application can be either faxed or mailed out upon request. The completed application must be mailed back.  The patient is notified of eligibility for the program.  
Application Requirements

The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Program Details

The medication is sent to either the doctor's office or the patient's home. The patient must contact the company to arrange for refills. Every year a new application is needed.
Last Updated July 08, 2010


                                         

Program 2 of 3 Scroll down to see them all.

This program provides generic medications at a discount.
Pharmaceutical Company Xubex Pharmaceuticals
Program Name Xubex Patient Assistance Program
Program Address PO Box 1244
Winter Park, Fl 32790-1244
Phone Number

866-699-8239
Fax Number 407-671-7960
Medications on Program nortriptyline Capsules 10mg, 25mg, 50mg, 75mg (Pamelor)
Application Forms Xubex Patient Assistance Program
On-line Application
 No on-line application available at this time
Web Site Click to go to program's web site
Eligibility Guidelines and Notes

Applicants with insurance are eligible. This program does not have income limitations. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified.  This is a program for generic medications only. There are fees for the medications:$20-$45 for a 90 day supply. ($40 or $60 for a 180 day supply and $80 or $120 for a 360 day supply.) Check the website for the exact price. A shipping and ordering fee of $3.85 is charged for each order. Patients may apply online or print the prescription, complete and fax to the Xubex pharmacy for processing. Requests may be expedited by having the physician fax the completed form to the Xubex pharmacy.
Application Process

Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back.    The medication is shipped within 10 business days.
Application Requirements

The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Program Details

The medication is sent to either the doctor's office or the patient's home. The company automatically sends out refills. Once a year a new application with financial documentation is needed.
Last Updated August 04, 2010


                                         

Program 3 of 3.

This is a discount card program.
Pharmaceutical Company Mallinckrodt
Program Name Covidien/Mallinckrodt Patient Assistance Program
Program Address MaxCare
PO Box 18204
Oklahoma City, OK 73154
Phone Number

800-259-7765, opt 2

405-525-5248
Fax Number 405-525-7523
Medications on Program Pamelor Capsules 10mg, 25mg, 50mg, 75mg (nortriptyline)
Pamelor Solution 10mg/5ml (nortriptyline)
Application Forms Mallinckrodt Patient Assistance Program
On-line Application
 No on-line application available at this time
Web Site No link available.
Eligibility Guidelines and Notes

The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. If accepted, the patient must pay a co-pay of $20. No decision has been made about patients who are eligible for Medicare Part D but have not enrolled. The patient should still apply. If patient meets other guidelines they may be able to assist those in the donut hole.
Application Process

With the patient's permission, anyone concerned can call for an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.  The patient is notified of eligibility for the program.  
Application Requirements

The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Program Details

The patient is sent a pharmacy card to be used once a month.  Once a year the application process must be repeated.
Last Updated August 05, 2010