Namenda Patient Assistance Programs

Namenda: Apply for prescription assistance below

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

Rx Outreach Medications

(Program 1 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
  • Namenda (memantine)
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 Namenda prices here.

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Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

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Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

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Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

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Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

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Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top

Allergan Patient Assistance Program: Medications/Devices

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

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Namenda oral solution (memantine oral solution)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

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

Back to top