Contact info
- Phone
- 1-866-982-5438
- Mailing address
- 90 East Halsey Rd.Suite 210Parsippany, NJ 07054
Eligibility
- Patient must not have prescription coverage for medication needed and cannot be covered by or be eligible for any government prescription coverage such as Medicaid, Veteran's Administration, or any state or local programs.
- Patient cannot be enrolled in Medicare Part D.
- Program offers co-pay assistance, and patient assistance programs are for eligible patients.
- Income limit, single
- 200% of the federal poverty level
- Income limit, couple
- 200% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- 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
- Prescription
- Prescriber license number
- NPI number
- DEA number
- Who can sign
- Physician
- Application can be faxed
- No
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- 90-day supply
- Time to first delivery
- 0–2 weeks
- Refills
- A new application with new prescription is needed for refills.
- Staying enrolled
- New application every 3 months
- New proof of income every 12 months
- New prescription every 3 months
Medications covered
- Equetro (carbamazepine)