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Program Details

MYLAN
My EpiPen Savings Card

EpiPen Jr (epinephrine)
 
CONTACT INFO
Address:
,
Phone: 1-800-657-7613 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
Eligibility Info:
  • This SAVINGS card can be redeemed only by patients or patient guardians who are 18 years of age or older who are a resident of the United States and its territories.
  • Not valid for uninsured patients (except for commercially insured patients without coverage for EpiPen Auto-Injector) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TriCare (regardless of whether EpiPen Auto-Injector is covered by such government program); if the patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; or if the patient's insurance plan is paying the entire cost of this prescription.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: None
    Physician License #
    Required:
    Not Required
    Prescriber Signature
    Allowed:
    Not Required
    Application may be
    faxed:
    Not Published
    Eligibility determination
    letter sent:
    Not Published
    MEDICATION
    Receives: Pharmacy Card
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Not Published
    Refill Policy: Patient brings card to pharmacy to receive savings. Card can be used up to 6 times on EpiPen 2 packs.
    Other Information:
  • Maximum savings of $300 off per 2 pack.
  • Last Updated: 11/12/2020

     

     

     


    Application Forms
    & Instructions

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



     

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