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

Covidien/Mallinckrodt Patient Assistance Program

Provided by: Mallinckrodt Pharmaceuticals

Attn: MaxCare
PO Box 16430
Oklahoma City, OK 73113

TEL: 800-259-7765, opt. 3

ALT PHONE: 405-525-5248
FAX: 405-213-1521
Languages Spoken:


Program Website


Program Applications and Forms

Covidien/Mallinckrodt Patient Assistance Program Application



  • Anafranil capsule (clomipramine)

Eligibility Requirements   

Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified


Obtaining Call
Receiving Faxed, emailed or downloaded from website
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified
Decision Timeframe Not specified


Amount/Supply Up to a 30 day supply or 90 Qty
Sent To Patient sent card to be used at pharmacy
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application yearly

Additional Information

For the medication Exalgo, the quantity is 120.

For the medication Roxicodone, the quantity is 360 for the 15mg and 180 for the 30mg.

If accepted, the patient must pay a copay of $20.

Updated May 01, 2018