Epipen Patient Assistance Programs

Epipen: Apply for prescription assistance below

If you are eligible, the programs below can help you afford EpiPen. 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.

Looking for a different medication?

HealthWell Foundation Copay Program

(Program 1 of 13 — Scroll down to see them all)

Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • EpiPen (epinephrine)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 3-5 business days
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Updated September 24, 2018

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

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Kaleo Cares Patient Assistance Program (Auvi-Q)

(Program 2 of 13 — Scroll down to see them all)

Provided by: Kaleo, Inc.
None
TEL: 877-302-8847
FAX: 800-943-1730
Languages Spoken:
English
Program Website
Medications
  • Auvi-Q (epinephrine)
Eligibility Requirements
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? Varies
  • Income At or below 100% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified by phone
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Patient's home
  • Delivery Time Within 48 hours
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
None
Updated September 14, 2018

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

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Rx Outreach Medications

(Program 3 of 13 — Scroll down to see them all)

Provided by: Rx Outreach
PO Box 66536 St. Louis, MO 63166-6536
TEL: 888-796-1234
FAX: 800-875-6591
Languages Spoken:
English, Spanish
Program Website
Medications
  • None (epinephrine)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Not required
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning Fax or E-Prescribe online
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section and sign
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Usually same day
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Company contacts patient to arrange
  • Limit Only limited by manufacturer's guidelines
  • Re-application New application yearly
Additional Information
Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s).
Updated September 10, 2018

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

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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

(Program 4 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
ALT PHONE: 800-796-9526
FAX: 877-427-7290
Languages Spoken:
English
Program Website
Medications
  • EpiPen 2-Pak injection (epinephrine injection)
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 Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call
  • 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 of Approval and Patient notified of denial
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 5-7 business days
  • Refill Proces Yearly a new application with new documentation
  • Limit Not specified
  • Re-application Varies
Additional Information
None
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 EpiPen prices here.

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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

(Program 5 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
ALT PHONE: 800-796-9526
FAX: 877-427-7290
Languages Spoken:
English
Program Website
Medications
  • EpiPen 2-Pak injection (epinephrine injection)
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 Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call
  • 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 of Approval and Patient notified of denial
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 5-7 business days
  • Refill Proces Yearly a new application with new documentation
  • Limit Not specified
  • Re-application Varies
Additional Information
None
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 EpiPen prices here.

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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

(Program 6 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
ALT PHONE: 800-796-9526
FAX: 877-427-7290
Languages Spoken:
English
Program Website
Medications
  • EpiPen 2-Pak injection (epinephrine injection)
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 Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call
  • 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 of Approval and Patient notified of denial
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 5-7 business days
  • Refill Proces Yearly a new application with new documentation
  • Limit Not specified
  • Re-application Varies
Additional Information
None
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 EpiPen prices here.

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Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program

(Program 7 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
781 Chestnut Ridge Road Morgantown, WV 26505
TEL: 800-796-9526
ALT PHONE: 800-796-9526
FAX: 877-427-7290
Languages Spoken:
English
Program Website
Medications
  • EpiPen 2-Pak injection (epinephrine injection)
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 Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call
  • 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 of Approval and Patient notified of denial
  • Decision Timeframe Within 2 weeks
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 5-7 business days
  • Refill Proces Yearly a new application with new documentation
  • Limit Not specified
  • Re-application Varies
Additional Information
None
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 EpiPen prices here.

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EpiPen4School Program

(Program 8 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

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EpiPen4School Program

(Program 9 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

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EpiPen4School Program

(Program 10 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

Back to top

EpiPen4School Program

(Program 11 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

Back to top

EpiPen4School Program

(Program 12 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

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EpiPen4School Program

(Program 13 of 13 — Scroll down to see them all)

Provided by: Mylan Specialty
c/o BioRidge Pharma, LLC Attn: Kristina Paich
TEL: 973-845-7600
ALT PHONE: 973-845-7600
FAX: 973-718-4328
Languages Spoken:
English
Program Website
Medications
  • EpiLocker (epinephrine carton)
Eligibility Requirements
  • Insurance Status Not applicable
  • Those with Part D Elibible? Not applicable
  • Income Not applicable
  • Diagnosis/Medical Criteria Not disclosed
  • U.S. Residency Required? Must show residency in US
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Not applicable
  • Applicant's Action Not applicable
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies. *see below for details
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Contact program for details.
Additional Information
For grades K through 12 licensed as an educational facility under all applicable laws.
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 EpiPen prices here.

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