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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Mylan Specialty

781 Chestnut Ridge Road
Morgantown, WV 26505

TEL: 800-796-9526


ALT PHONE: 800-395-3376
FAX: 877-427-7290
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program Application

 

Medications

  • EpiPen 2-Pak injection (epinephrine)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below 400% of FPL
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed, emailed, mailed or downloaded
Returning Email, fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified of Approval and Patient notified of denial
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Yearly a new application with new documentation
Limit Not specified
Re-application Varies
   

Additional Information


Updated March 21, 2019


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

EpiPen4School Program

This program provides both brand name and generic name

Provided by: Mylan Specialty

c/o BioRidge Pharma, LLC
Attn: Kristina Paich

TEL: 973-845-7600


ALT PHONE: 800-395-3376
FAX: 973-718-4328
Languages Spoken:

English

Program Website

 

Program Applications and Forms

EpiPen4Schools Program Free Certification Form

EpiPen4Schools Program Replenishment Certification Form

EpiPen4Schools Program Standing Order Protocol Form

EpiPen4Schools Program Standing Order Certification Form

 

Medications

  • EpiPen 2-Pak injection (epinephrine)
 

Eligibility Requirements   

Insurance Status Not applicable
Those with Part D Eligible? Not applicable
Income Not applicable
Diagnosis/Medical Criteria Not disclosed
US Residency Required? Must show residency in US
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Fax
Doctor's Action Not applicable
Applicant's Action Not applicable
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Varies. *see below for details
Delivery Time Not specified
Refill Process Contact program for details.
Limit Varies
Re-application Contact program for details.
   

Additional Information

For grades K through 12 licensed as an educational facility under all applicable laws.


Updated March 21, 2019