Restoril Prescription Assistance Programs

Restoril: Apply for prescription assistance below

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

Mallinckrodt Patient Assistance Program

(Program 1 of 2 — 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
  • Restoril (temazepam)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, if in the donut hole
  • Income At or below 200% 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 Roxicodone, the quantity is 360 for the 15mg and 180 for the 30mg. If accepted, the patient must pay a copay of $20.
Updated November 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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Rx Outreach Medications

(Program 2 of 2 — 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
  • Restoril (temazepam)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income At or below 400% 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 17, 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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