Contact info
- Phone
- 1-866-756-2844
- Fax
- 1-877-436-4188
Eligibility
- Patients must meet eligibility criteria for PAP, which includes: 1) US citizenship, 2) on-label diagnosis, 3) meets financial threshold, 4) patient is uninsured, functionally uninsured, or has a financial hardship.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider or patient
- Supply per shipment
- Up to 3-month supply
- Time to first delivery
- 0–2 weeks
- Refills
- Program will contact patient to arrange
- Staying enrolled
- Must re-enroll at end of calendar year
Medications covered
- Xcopri (cenobamate tablets)