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

MuGard Patient Reimbursement and Support

This program provides brand name medications at no or low cost

Provided by: AMAG Pharmaceuticals, Inc.

The AMAG Assist
11800 Weston Parkway,
Cary, NC 27513

TEL: 844-635-2624


FAX: 877-591-2505
Languages Spoken:

English, Others By Translation Service

Program Website

 

Patient Assistance Applications

MuGard Prescription Form

MuGard Patient Assistance Program Guide

 

Brand Name Medications Covered

 
  • MuGard oral solution
 

Generic Name

 
  • mucadhesive oral solution
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? No
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax
Doctor's Action Complete section and sign
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Within 2-3 days
Refill Process Determined on a case by case basis
Limit Up to 12 months of medication for each calendar year
Re-application Doctor contacts company
   

Additional Information


Updated September 28, 2018