Exalgo Patient Assistance Programs

Exalgo: Apply for prescription assistance below

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

Covidien/Mallinckrodt Patient Assistance Program

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

Provided by: Mallinckrodt Pharmaceuticals
Attn: MaxCare PO Box 16430 Oklahoma City, OK 73113
TEL: 800-259-7765, opt. 3
ALT PHONE: 800-259-7765, opt. 3
FAX: 405-213-1521
Languages Spoken:
English Others By Translation Service
Program Website
Medications
  • Exalgo tablet (hydromorphone tablet)
Eligibility Requirements
  • Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
  • Those with Part D Elibible? Yes
  • Income Between 200-300% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident with a Social Security Number.
Application
  • Obtaining Call
  • Receiving Faxed, emailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • 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
Medication
  • 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 Proces Not specified
  • Limit Not specified
  • Re-application New application yearly
Additional Information
For the medication Exalgo, the quantity is 120. 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 August 30, 2018

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

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