Actavis and Allergan


You must be a resident of the US.

Your prescribing physician must be licensed to provide healthcare in the US.

You may not have Medicare Part D or other prescription drug coverage. If you have Medicare Part D,

you have to have applied and been denied Low Income Subsidy (LIS) by the Social Security


No specific income guidelines are given. It can be assumed you must be at least at or below the

federal poverty line.

Medications covered by the Patient Assistance Program:

Armour ® Thyroid (thyroid tablets, USP)

Bystolic ® (nebivolol) Tablets

Campral ® (acamprosate calcium) Delayed-Release Tablets

Canasa ® (Mesalamine, USP)

Daliresp ® (roflumilast) Tablets

Fetzima ® (levomilnacipran) Extended Release Capsules & Titration Pack

Gelnique ® (oxybutynin chloride 10 % gel)

Infed ® (Iron Dextran) Injection

Linzess ® (linaclotide) Capsules

Namenda ® (memantine HCl) Tablets

Namenda ® (memantine HCl) Oral Solution

Namenda XR ® (memantine HCl) Extended Release Capsules & Titration Pack

Pylera ® (bismuth subcitrate potassium, metronidazole, and tetracycline hydrochloride

Rapaflo ® (silodosin) capsule

Rectiv ® (nitroglycerin) Ointment 0.4%

Saphris ® (asenapine maleate) sublingual tablet

Savella ® (milnacipran HCl) Tablets & Titration Pack

Trelstar ® (triptorelin pamoate) injectable suspension

Tudorza ® Pressair® (aclidinium bromide inhalation powder)

Ultresa ® (Pancrelipase)

Viibryd ® (vilazodone HCl) Tablets & Titration Pack

Viokace ® (Pancrelipase)

Zenpep ® (Pancrelipase)

Phone: (706) 208 9700   Mail: