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Program Details

VIATRIS, INC.
Viatris Patient Assistance (Group 2 Medications)

EpiPen (epinephrine)
 
CONTACT INFO
Address:
,
Phone: 1-888-417-5782 Provider Phone:
Fax: 1-866-792-7945 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be fully uninsured.
  • Each applicant will be individually assessed for program eligibility based on the information provided on the application.
  • 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
    APPLICATION
    Attachments Required: Not Published
    Physician License #
    Required:
    State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Not Published
    MEDICATION
    Receives: As prescribed
    Shipped To: Provider
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Not Published
    Refill Policy: Not Published
    Other Information:

    Last Updated: 03/15/2024

     

     

     


    Application Forms
    & Instructions

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


    DocumentForm (English)



     

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