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      Patient Assistance Program Center

Program Details

Novartis Patient Assistance Foundation, Inc.

Focalin XR (dexmethylphenidate hcl)
Address: P.O. Box 52029
Phoenix, AZ 85072-2029
Phone: 1-800-277-2254 Provider Phone:
Fax: 1-855-817-2711 Website: Novartis Patient Assistance Foundation Program Website
Eligibility Info:
  • To be eligible for this program, patients must be a U.S. Resident, meet the income requirements, and must not have prescription drug coverage.
  • Medicare beneficiaries who enroll in a Part D plan may be considered for the Novartis Patient Assistance Foundation Program (NPAFP) based upon the following criteria:

    * Patients on Novartis transplant or oncology products who enroll in a Part D plan can continue to receive help through NPAFP as long as they continue to meet eligibility criteria for NPAFP, do not qualify for the LIS, and show financial hardship in affording their medications despite the Part D benefit coverage;

    * Other cases will be evaluated individually, based on the particular Novartis product, specific circumstances and financial hardship experienced.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Physician License #
    Either DEA or State
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    Receives: Medication
    For some medications such as Focalin XR and Ritalin LA, a pharmacy card will be sent to the patient. The patient must take the pharmacy card and a valid prescription to their retail pharmacy to receive the product.
    Shipped To: Provider
    Note: For Clozaril, Focalin XR and Ritalin LA the patient will receive a pharmacy card.
    Quantity in Shipment: 90 days
    Some medications are sent in 30 day or 90 day supplies.
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: 3 refills
    Program has an automated refill system.
    Other Information:

    Last Updated: 09/22/2015




    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.

    DocumentForm (English)

    Document Form (Spanish)

    Document Instructions (English)


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