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

TEL: Closed Program

Languages Spoken:

English, Others By Translation Service


Patient Assistance Applications


Generic Name Medications


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


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

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