Clozapine Patient Assistance Programs

Clozapine: Apply for prescription assistance below

If you are eligible, the programs below can help you afford clozapine. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

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TEVA Patient Assistance Program (Clozapine)

(Program 1 of 2 — Scroll down to see them all)

Provided by: TEVA Pharmaceuticals
None
TEL: 800-292-4283
ALT PHONE: 800-292-4283
FAX: 253-218-0875
Languages Spoken:
English
Program Website
Medications
  • None (clozapine)
Eligibility Requirements
  • Insurance Status No insurance coverage for needed medication
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Must provide diagnosis code
  • U.S. Residency Required? Must be a US resident
Application
  • Obtaining Call
  • Receiving Faxed, emailed or mailed
  • Returning The completed application can be faxed, mailed or emailed back.
  • Doctor's Action Complete section, sign; attach lab results
  • Applicant's Action Complete section and sign
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Once approved; shipped same day
  • Refill Proces Doctor must fax current lab results to company
  • Limit Not specified
  • Re-application New application yearly
Additional Information
None
Updated July 16, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for clozapine prices here.

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Mylan Clozapine Patient Assistance Program (MCPAP)

(Program 2 of 2 — Scroll down to see them all)

Provided by: Mylan Pharmaceuticals, Inc.
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
FAX: 877-427-7290
Languages Spoken:
English, Spanish
Program Website
Program Applications and Forms
Medications
  • None (clozapine)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call or download
  • Receiving Faxed, emailed, mailed or downloaded
  • Returning The completed application can be faxed, mailed or emailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Doctor notified
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Up to 90 day supply
  • Sent To Pharmacy
  • Delivery Time Shipped beginning of next month
  • Refill Proces Automatically sent out
  • Limit Not specified
  • Re-application New application every 6 months
Additional Information
There are two steps and two sets of paperwork for this program. The first step is to register the patient, which is required for any patient taking Clozapine, regardless of insurance or financial situations. Call 800-843-9915 to register. This is a two-page form that the patient, physician and pharmacist must fill out.
Updated June 18, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for clozapine prices here.

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