Peganone Prescription Assistance Programs

Peganone: Apply for prescription assistance below

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

Recordati Reimbursement Hotline

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

Provided by: Recordati Rare Diseases
PO Box 4280 Gaithersburg, MD 20885
TEL: 866-209-7604
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Peganone tablet (ethotoin tablet)
Eligibility Requirements
  • Insurance Status Not specified
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Doctor/Doctor's office must call for prescreening
  • Receiving Sent to Doctor's office
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach proof of income and any insurance information
  • Decision Communicated Doctor notified
  • Decision Timeframe Within 24-48 hours
Medication
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office
  • Delivery Time Within 3-5 business days
  • Refill Proces Doctor's office must contact the company
  • Limit Not applicable
  • Re-application New application every 6 months
Additional Information
Insurance benefits, patient assistance, claims assistance and/or other reimbursement help is offered. Applicant must attach proof of income for all adults in the household. This program also provides copay assistance for Penhematin. Contact program for details.
Updated September 11, 2019

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

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