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 who meet other eligibility requirements. 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.


The following branded drugs and devices are available through
the Forest Pharmaceuticals, Inc. Patient Assistance Program
DRUG STRENGTH(S) SIZE
Armour® Thyroid
(thyroid tablets, USP)
¼ gr, ½ gr, 1 gr, 1 ½ gr, 2 gr, 3 gr, 4 gr, 5 gr 100 ct. bottle
Bystolic® (nebivolol) Tablets 2.5 mg, 5 mg, 10 mg, 20 mg 100 ct. bottle
Campral® (acamprosate calcium)
Delayed-Release Tablets
333 mg 180 ct. bottle
Daliresp® (roflumilast) Tablets 500 mcg 30 ct. bottle
Fetzima™ (levomilnacipran) Extended Release Capsules 20 mg, 40 mg, 80 mg, 120 mg 30 ct. bottle
Fetzima™ (levomilnacipran) Extended Release Capsules Titration Pack 20 mg and 40 mg combination pack 2 x 20 mg capsules;
26 x 40 mg capsules
Linzess (linaclotide) Capsules 145 mcg, 290 mcg 30 ct. bottle
Namenda® (memantine HCI) Tablets 5 mg, 10 mg 60 ct. bottle
Namenda® (memantine HCI)
Oral Solution
10 mg = 5 mL 360 mL bottle
Namenda® (memantine HCI)
Titration Pak
5 mg and 10mg combination pack 28 x 5 mg tablets;
21 x 10 mg tablets
Namenda XR (memantine HCI)
Extended Release Capsules
7 mcg, 14 mg, 21 mg, 28 mg 30 ct. bottle
Namenda XR (memantine HCI)
Extended Release Capsules
Titration Pack
7 mcg, 14 mg, 21 mg, and 28 mg combination pack 7 x 7 mg capsules,
7 x 14 mg capsules;
7 x 21 mg capsules;
7 x 28 mg capsules
Savella® (milnacipran HCI) Tablets 12.5 mg, 25 mg, 50 mg, 100 mg 60 ct. bottle
Savella® (milnacipran HCI)
Titration Pack
12.5 mg, 25 mg and 50 mg combination pack 5 x 12.5 mg tablets;
8 x 25 mg tablets;
42 x 50 mg tablets
Tudorza Pressair (aclidinium
bromide inhalation powder)
400 mcg 60 meter dose
Viibryd® (vilazodone HCI) Tablets 10 mg, 20 mg, 40 mg 30 ct. bottle
Viibryd® (vilazodone HCI)
Patient Starter Kit
10 mg, 20 mg, and 40 mg combination pack 7 x 10 mg tablets;
7 x 20 mg tablets;
16 x 40 mg tablets
DEVICE SIZE
AeroChamber-Plus® Flow-Vu
Mouthpiece*
N/A N/A
AeroChamber-Plus® Flow-Vu Mask* N/A Small, Medium, Large

* Maximum amount for AeroChamber® or AeroChamber® with mask is one per applicant in a six-month period.

  Controlled substances and generic drugs and devices are not available through the Forest Pharmaceuticals, Inc.
  Patient Assistance Program.

  ARMOUR®, BYSTOLIC®, SAVELLA®, and VIIBRYD® are registered trademarks of Forest Laboratories, Inc.
  AEROCHAMBER®/ AEROCHAMBER PLUS® are registered trademark of Trudell Medical International.
  CAMPRAL® is a registered trademark of Merck Santé.
  DALIRESP® is a registered trademark of Takeda GmbH.
  FETZIMA™ is a trademark of Forest Laboratories. 
  LINZESS is a registered trademark of Ironwood Pharmaceuticals, Inc.
  NAMENDA® and NAMENDA XR® is a registered trademark of Merz Pharma GmbH.
  TUDORZA and PRESSAIR are a registered trademark of Almirall, SA.


Frequently Asked Questions

Contact Us

  • Email
  • 800-851-0758
    7:30 AM - 5:00 PM (CT),
    Monday - Friday
  • Fax# 1-636-754-0570