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Patient Assistance Program

Actavis U.S. Patient Assistance Program

The Actavis Pharma, Inc. Patient Assistance Program provides certain Actavis products to patients in the United States who are unable to afford the cost of their medication and who meet other eligibility requirements.

Eligibility for this program is based upon information you and your licensed practitioner provide on the application form. If you are approved, you will receive a three-month supply of the Actavis product you require at no charge. Actavis will ship your medication to your licensed practitioner's office for them to dispense to you. 
 

The following medications and devices are available through the Actavis Pharma, Inc. Patient Assistance Program:

Medications / Devices 

  • Armour ® Thyroid (thyroid tablets, USP)
  • Bystolic ® (nebivolol) Tablets
  • Campral ® (acamprosate calcium) Delayed-Release Tablets
  • Canasa ® (Mesalamine, USP)
  • Daliresp ® (roflumilast) Tablets
  • Fetzima ®  (levomilnacipran) Extended Release Capsules & Titration Pack
  • Gelnique ® (oxybutynin chloride 10 % gel)
  • Infed ® (Iron Dextran) Injection
  • Linzess ® (linaclotide) Capsules
  • Namenda ® (memantine HCl) Tablets
  • Namenda ® (memantine HCl) Oral Solution
  • Namenda XR ® (memantine HCl) Extended Release Capsules & Titration Pack
  • Pylera ® (bismuth subcitrate potassium, metronidazole, and tetracycline hydrochloride
  • Rapaflo ® (silodosin) capsule
  • Rectiv ® (nitroglycerin) Ointment 0.4%
  • Saphris ® (asenapine maleate) sublingual tablet
  • Savella ® (milnacipran HCl) Tablets & Titration Pack
  • Trelstar ® (triptorelin pamoate) injectable suspension
  • Tudorza ® Pressair® (aclidinium bromide inhalation powder)
  • Ultresa ® (Pancrelipase)
  • Viibryd ® (vilazodone HCl) Tablets & Titration Pack
  • Viokace ® (Pancrelipase)
  • Zenpep ® (Pancrelipase)

Device

  • AeroChamber Plus ® Flow-Vu ®  Mouthpiece* / Flow-Vu ® Mask*


* Maximum amount for AeroChamber or AeroChamber with mask is one per applicant in a six-month period.

All trademarks and product names herein are the property of their respective owners.

Additional Information

LIS Information 
Medicare Information
Contact us
Actavis Pharma, Inc.
Patient Assistance Program
Phone: +1 800 851 0758
Fax: +1 844 708 0036
Mailing address:
Actavis, P.O. Box 66764
St. Louis, MO 63166