Patient Assistance Program

Welcome to the Forest Pharmaceuticals, Inc. Patient Assistance Program homepage. This program provides certain Forest products to patients who are unable to afford the cost of their medication and whose income falls below a certain limit. Eligibility for this program is based upon information you and your licensed practitioner provide on the application form. If you are approved, you will receive a three-month supply of the Forest product you require at no charge. Forest will ship your medication to your licensed practitioner's office for them to dispense to you.

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Commonly requested products available through the program:
Medication	Strength	Size
Aerobid^® Inhaler	N/A	7 gm canister
Aerobid^® M Inhaler	N/A	7 gm canister
*Aerochamber^®	N/A	N/A
*Aerochamber^® Mask	N/A	Sm, Reg, Lg
Armour^® Thyroid Tablets	¼, ½, 1, 1 ½, 2, 3, 4, 5 gr	100 ct. bottle
Bystolic^® Tablets	2.5, 5, 10 mg	100 ct. bottle
Campral^® Dose Pak	333 mg	180 ct.
Campral^® Tablets	333 mg	180 ct. bottle
Celexa™ Tablets	10, 20, 40 mg	100 ct. bottle
Levothroid^® Tablets	25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg	100 ct. bottle
Lexapro™ Tablets	10, 20 mg	100 ct. bottle
Namenda™ Titration Pak	N/A	4 week therapy
Namenda™ Tablets	5, 10 mg	60 ct. bottle
Tessalon^® Perles	100, 200 mg	100 ct. bottle
Theochron™ Tablets	100, 200, 300 mg	100 ct. bottle
Thyrolar^® Tablets	¼, ½, 1, 2, 3	100 ct. bottle
Tiazac^® Capsules	120, 180, 240, 300, 360, 420 mg	90 ct. bottle
* Maximum amount for Aerochamber^® or Aerochamber^® with mask is one per patient in a six-month period. Controlled substances are not available on FPI's program.

Commonly requested products available through the program:

Medication

Strength

Size

Aerobid^® Inhaler

N/A

7 gm canister

Aerobid^® M Inhaler

N/A

7 gm canister

*Aerochamber^®

N/A

*Aerochamber^® Mask

N/A

Sm, Reg, Lg

Armour^® Thyroid Tablets

¼, ½, 1, 1 ½, 2, 3, 4, 5 gr

100 ct. bottle

Bystolic^® Tablets

2.5, 5, 10 mg

100 ct. bottle

Campral^® Dose Pak

333 mg

180 ct.

Campral^® Tablets

333 mg

180 ct. bottle

Celexa™ Tablets

10, 20, 40 mg

100 ct. bottle

Levothroid^® Tablets

25, 50, 75, 88, 100, 112, 125, 137, 150,
175, 200, 300 mcg

100 ct. bottle

Lexapro™ Tablets

10, 20 mg

100 ct. bottle

Namenda™ Titration Pak

N/A

4 week therapy

Namenda™ Tablets

5, 10 mg

60 ct. bottle

Tessalon^® Perles

100, 200 mg

100 ct. bottle

Theochron™ Tablets

100, 200, 300 mg

100 ct. bottle

Thyrolar^® Tablets

¼, ½, 1, 2, 3

100 ct. bottle

Tiazac^® Capsules

120, 180, 240, 300, 360, 420 mg

90 ct. bottle

* Maximum amount for Aerochamber^® or Aerochamber^® with mask is one per patient in a six-month period.
Controlled substances are not available on FPI's program.