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: Closed Program


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

English, Others By Translation Service

 

Patient Assistance Applications

Covidien/Mallinckrodt Patient Assistance Program Application

 

Generic Name Medications Covered

 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes, if in the donut hole
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes and have social security number
   

Application

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
   

Medication

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

Closed Program

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 July 11, 2019