Pamelor Patient Assistance Programs

Pamelor: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Pamelor. 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 3 — 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
  • Pamelor (nortriptyline)
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 Pamelor prices here.

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Rx Outreach Medications

(Program 2 of 3 — 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
  • Pamelor (nortriptyline)
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 Pamelor prices here.

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Covidien/Mallinckrodt Patient Assistance Program

(Program 3 of 3 — 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
  • Pamelor capsule (nortriptyline capsule)
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 Pamelor prices here.

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