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      Patient Assistance Program Center

Program Details

Patient Assistance Program

Mucomyst Solution (acetylcysteine)
Address: 6931 Arlington Road
2nd Floor
Bethesda, MD 20814
Phone: 1-888-315-4154 Provider Phone:
Fax: 1-877-868-5952 Website: Program Website
Eligibility Info:
  • Patient may have insurance.
  • Patient must a diagnosis of cystic fibrosis.
  • Patient must be requesting assistance for an FDA approved medication or paired drug delivery device for the nebulized treatment of CF-related pulmonary disease, or an FDA approved medication for the treatment of pancreatic insufficiency related to CF.
  • Patient's household income must be equal to or less than 400 percent of the federal poverty level for a single CF patient household, or equal to or less than 500 percent of federal poverty level for a multiple CF patient household.
  • Income at or below: Single 400 % FPL
      Couple 400 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: No
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Residency verification Copy of insurance cards, if applicable
    Physician License #
    Not Required
    Prescriber Signature
    Not Published
    Application may be
    Eligibility determination
    letter sent:
    Not Published
    Benefit Card
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    Refill Policy: Not Published
    Other Information:

    Last Updated: 05/12/2015




    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)

    Document Instructions (Spanish)

    Document CFPAF Notarized Letter

    Document Spanish - CFPAF Notarized Letter


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