Aciphex Patient Assistance Program (PAP)
Prescription Medication Assistance Organization Contact
PO Box 220458
Charlotte, NC 28222
Phone: (800) 523-5870
Fax: (800) 526-6651
Medications sent to: Patientís Doctor
Prescription Medications/Products Covered:
Program Information And Resources:
Aciphex Application Form
Program Eligibility Requirements:
Eisai Inc and Janssen Pharmaceutica, Inc have developed the Aciphex Patient Assistance Program (PAP) for those U.S. residents who lack access to prescription drug coverage and meet specific financial criteria.
Additional Information and/or Requirements (known):
If necessary, patient may reapply after initial supply.