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Zonegran: Apply for prescription assistance below
If you are eligible, the programs below can help you afford Zonegran. 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.
Rx Outreach Medications
(Program 1 of 2. 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 11/15/2016 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Zonegran prices here.
Xubex Patient Assistance Program
(Program 2 of 2. Scroll down to see them all.)
Provided by: Xubex |
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PO Box 1244
Winter Park, Fl 32790-1244
TEL: 866-699-8239 ALT PHONE: 407-478-2663 FAX: 407-671-7960 |
Languages Spoken: English Program Website |
Program Applications and Forms
Medications |
Eligibility Requirements |
||
| Insurance Status |
May have insurance
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| Those with Part D Eligible? | Yes, but contact program for details | |
| Income | No limits | |
| Diagnosis/Medical Criteria | Not specified | |
| US Residency Required? | The patient must also be a US resident. | |
Application |
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| Obtaining | Call or download | |
| Receiving | Faxed, mailed 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 and sign | |
| Decision Communicated | Not specified | |
| Decision Timeframe | Not specified | |
Medication |
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| Amount/Supply | Varies | |
| Sent To | Doctor's office or patient's home | |
| Delivery Time | Within 10 days | |
| Refill Process | Automatically sent out | |
| Limit | Varies per medication | |
| Re-application | New application, new documentation yearly | |
Additional Information |
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No proof of income is required. Check the website for the exact price.
This service is not currently available in Montana.
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| Updated 10/31/2016 |
If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Zonegran prices here.
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