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Topamax: Apply for prescription assistance below
If you are eligible, the programs below can help you afford Topamax. 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.
Johnson & Johnson Patient Assistance Foundation, Inc. Hospital Access Patient Assistance Program
(Program 1 of 4. Scroll down to see them all.)
Provided by: Johnson & Johnson Patient Assistance Foundation, Inc. |
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PO Box 220455
Charlotte, NC 28222-0455
TEL: 800-652-6227 FAX: 800-521-2437 |
Languages Spoken: English Program Website |
Program Applications and Forms
Medications |
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Eligibility Requirements |
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| Insurance Status |
Must be uninsured
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| Those with Part D Eligible? | Not specified | |
| Income | Based on FPL | |
| Diagnosis/Medical Criteria | Not applicable | |
| US Residency Required? | Must be residing in the US or US territory | |
Application |
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| Obtaining | Representative from the hospital must call for an application or download it from the website | |
| Receiving | Faxed, mailed or downloaded from website | |
| Returning | The completed application can be faxed or mailed back. | |
| Doctor's Action | Hospital must complete product request form for each replacement | |
| Applicant's Action | Not specified | |
| Decision Communicated | Not specified | |
| Decision Timeframe | Not specified | |
Medication |
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| Amount/Supply | Not specified | |
| Sent To | Hospital | |
| Delivery Time | Not specified | |
| Refill Process | Not specified | |
| Limit | Not specified | |
| Re-application | New application, new documentation yearly | |
Additional Information |
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This program allows eligible hospitals to receive free medications to give to qualified outpatients directly.
Contact the program for more details (1-800-652-6227).
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| Updated 8/1/2017 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Topamax prices here.
Supernus Patient Assistance Program
(Program 2 of 4. Scroll down to see them all.)
Provided by: Supernus Pharmaceuticals, Inc. |
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c/o The Lash Group, Inc.
9717 Key West Avenue
Rockville, MD 20850
TEL: 866-398-0833 FAX: 855-998-1515 |
Languages Spoken: English Program Website |
Program Applications and Forms
Medications |
Eligibility Requirements |
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| Insurance Status |
Must be uninsured
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| Those with Part D Eligible? | No | |
| Income | Not disclosed | |
| Diagnosis/Medical Criteria | Medically Necessary as determined by a Doctor | |
| US Residency Required? | The patient must also be a US resident. | |
Application |
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| Obtaining | Download from website | |
| Receiving | Downloaded from website | |
| Returning | The completed application must be faxed back. | |
| Doctor's Action | Complete section and sign | |
| Applicant's Action | Complete section and sign | |
| Decision Communicated | Not specified | |
| Decision Timeframe | Not specified | |
Medication |
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| Amount/Supply | Up to 1 month supply | |
| Sent To | Patient's home | |
| Delivery Time | Not specified | |
| Refill Process | Company contacts patient to arrange | |
| Limit | Not specified | |
| Re-application | New application yearly | |
Additional Information |
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This program also provides copay assistance.
www.oxtellarxr.com
www.trokendixrhcp.com
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| Updated 6/5/2017 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Topamax prices here.
Rx Outreach Medications
(Program 3 of 4. Scroll down to see them all.)
Provided by: Rx Outreach |
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PO Box 66536
St. Louis, MO 63166-6536
TEL: 888-796-1234 FAX: 800-875-6591 |
Languages Spoken: English, Spanish Program Website |
Program Applications and Forms
Medications |
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Eligibility Requirements |
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| Insurance Status |
May have insurance
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| Those with Part D Eligible? | Yes | |
| Income | At or below 300% of FPL | |
| Diagnosis/Medical Criteria | Not required | |
| US Residency Required? | The patient must also be residing in the US. | |
Application |
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| 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 |
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| Amount/Supply | Varies | |
| Sent To | Doctor's office or patient's home | |
| Delivery Time | Not specified | |
| Refill Process | Company contacts patient to arrange | |
| Limit | Only limited by manufacturer's guidelines | |
| Re-application | New application yearly | |
Additional Information |
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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).
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| Updated 6/27/2017 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Topamax prices here.
Rx Outreach Medications
(Program 4 of 4. Scroll down to see them all.)
Provided by: Rx Outreach |
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PO Box 66536
St. Louis, MO 63166-6536
TEL: 888-796-1234 FAX: 800-875-6591 |
Languages Spoken: English, Spanish Program Website |
Program Applications and Forms
Medications |
|
|
Eligibility Requirements |
||
| Insurance Status |
May have insurance
|
|
| Those with Part D Eligible? | Yes | |
| Income | At or below 300% of FPL | |
| Diagnosis/Medical Criteria | Not required | |
| US 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 Process | Company contacts patient to arrange | |
| Limit | Only limited by manufacturer's guidelines | |
| Re-application | New application yearly | |
Additional Information |
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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).
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| Updated 6/27/2017 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Topamax prices here.
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Home | About Online Pharmacies | Rogue Pharmacies | Testimonials | Save Money | My PharmacyChecker | Manage Price Alerts
En Español | News Releases | New Blog Post | Blog Archive | Join Free Newsletter
Verification Program | Other Services | Affiliate Program | Privacy Policy | Help/Contact Us
Copyright 2018, PharmacyChecker.com LLC. All rights reserved. PharmacyChecker.com is a registered service mark of PharmacyChecker.com, LLC.