Modafinil Patient Assistance Program

(armodafinil) & Provigil (modafinil) Prior Authorization ...
Your patient's pharmacy benefit program is administered by UnitedHealthcare, which uses OptumRx for certain pharmacy benefit services. Your patient’s For Provigil (modafinil) 200mg requests, please answer the following: ... Retrieve Content

TO: FAX: PAGE(S): RE: DATE: CASE - RxResource.org
FAX: PAGE(S): RE: DATE: CASE: PRODUCT: FOUNDATION Patient Assistance Program provides prescription medicines at no cost to patients who qualify. If you have no prescription drug coverage and meet the income guidelines below, ... Fetch Document

PROVIGIL / NUVIGIL (modafinil / Armodafinil) RATIONALE FOR ...
PROVIGIL / NUVIGIL (modafinil / armodafinil) RATIONALE FOR INCLUSION IN PA PROGRAM . Background . treatment of choice for a patient, a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating Provigil. ... Get Document

PATIENT INFORMATION BROCHURE - Amazon S3
– modafinil (Provigil And pATIEnT ASSISTAncE. 8 Getting access to BOSULIF If you are eligible, the BOSULIF Co-pay Program can help lower your out-of-pocket costs for BOSULIF. If eligible, you will receive 80% off ... View Doc

Cariprazine - Wikipedia
Cariprazine, sold under the brand names Vraylar in the United States and Reagila in Europe, One review characterized the frequency of these events as "not greatly different from that seen in patient treated with placebo" ... Read Article

NeedyMeds
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Providing you with High-Quality, Low-Cost Prescription Drugs. ... Doc Viewer

Provigil Savings program
Compare prices and print coupons for Provigil (Modafinil) and other Narcolepsy, Sleep Apnea, and Fatigue drugs at CVS, Walgreens, and other pharmacies. The MYLAN patient assistance program offers free medication to people who otherwise cannot afford their medications.. ... Visit Document

INSTRUCTIONS (An Incomplete Application Will Delay Processing ...
Thank you for your interest in the TEVA CARES FOUNDATION Patient Assistance Program which provides prescription medicines at no cost to patients who qualify. If you INSTRUCTIONS (An incomplete application will delay processing) Patient: 1. Complete . ALL. fields on page one. ... Read Here

Prior Authorization, Pharmacy And Health Case Management ...
Patient assistance program I.D. number: Patient assistance program contact person name and phone number: Contact name: Provide medical rational why modafinil has been prescribed off-label instead of an alternate drug with an approved indication for this condition. ... Visit Document

TO: FAX: PAGE(S): RE: CASE: PRODUCT - Cephaloncares.com
FOUNDATION Patient Assistance Program provides prescription medicines at no cost to patients who qualify. If you have no prescription drug coverage and meet the income guidelines below, you may qualify for this program. ... Read More

MEDICARE PART D COVERAGE CRITERIA PROVIGIL (modafinil)
MEDICARE PART D COVERAGE CRITERIA . PROVIGIL (modafinil) • Patient has treatment failure or intolerance to CPAP, AND • Dose does not exceed FDA label maximum for the diagnosis, AND • Request must be reviewed with a Blue Shield Pharmacist. ... Content Retrieval

The Children’s Institute Expands Its PWS Footprint
The efficacy of modafinil (brand name Provigil), a central stimulant, on excessive daytime sleepiness in children and adolescents with PWS. The efficacy of modafinil was evaluated in Sandoz Patient Assistance Program – assists in obtaining Omnitrope to ... Fetch Full Source

HIGHLIGHTS OF PRESCRIBING INFORMATION WARNINGS AND ...
HIGHLIGHTS OF PRESCRIBING INFORMATION See full prescribing information for PROVIGIL. PROVIGIL® (modafinil) tablets, for oral use, C-IV Initial U.S. Approval: 1998 treatment of choice for a patient, a maximal effort to treat with CPAP for an adequate ... Retrieve Full Source

NOTES REGARDING THE EXCEPTION DRUG STATUS (EDS) PROGRAM
EXCEPTION DRUG STATUS PROGRAM . NOTES REGARDING THE EXCEPTION DRUG STATUS (EDS) PROGRAM • Duly licensed practitioners prescribing within their scope of practice (or • If a request has been denied, letters are sent to the patient and prescriber notifying them of the reason for the denial. ... Access Doc

Tricyclic Antidepressant - Wikipedia
Chemical structure of the prototypical and first marketed tricyclic antidepressant imipramine. Notice its three rings. Class identifiers; Chemical class: medical assistance should be sought immediately. gastric decontamination of the patient is achieved by administering, ... Read Article

RX OUTREACH APPLICATION - Amazon S3
RX OUTREACH APPLICATION TO ENROLL, PLEASE FILL OUT EACH FIELD First name: abuse or illegal distribution of any products in this program. Eszopiclone, Lorazepam, Modafinil, Methlyphenidate, Methylphenidate CD, Methylphenidate LA, Oxandrolone, ... Read Document

PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION
Nafcillin, bosentan, modafinil) may decrease palbociclib plasma concentration. In patients receiving IBRANCE, coadministration of strong CYP3A inducers should be avoided (see ; potential, advise the patient to avoid becoming pregnant with the use of adequate contraceptive ... Fetch Doc

Prior Authorization Request - Multiple Sclerosis
Multiple Sclerosis PDPD SGM Is the patient receiving Ampyra through samples or a manufacturer's patient assistance program? If Yes, skip to #4 Yes No . 3. Has the patient experienced improvement in walking speed or another objective measure of walking ability since ... Return Doc

ADHD And Narcolepsy Drug Therapy
ADHD and Narcolepsy Drug Therapy . manufacturer’s patient assistance programs) OR the patient is 19 years of age or younger and X. Nuvigil (armodafinil) and Provigil (modafinil) may be considered medically necessary for patients ... View Document