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.


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Commonly requested products available through the program:
Medication Strength Size
Armour® Thyroid Tablets ¼, ½, 1, 1 ½, 2, 3, 4, 5 gr 100 ct. bottle
Bystolic® Tablets 2.5, 5, 10, 20 mg 100 ct. bottle
Campral® Tablets 333 mg 180 ct. bottle
Celexa® Tablets 10, 20, 40 mg 100 ct. bottle
Daliresp® Tablets 500 mcg 90 ct. bottle
Levothroid® Tablets 25, 50, 75, 88, 100, 112, 125, 137, 150,175, 200, 300 mcg 100 ct. bottle
Lexapro® Tablets 5, 10, 20 mg 100 ct. bottle
Lexapro® Oral Solution 5 mg = 5 mL 240 mL bottle
Namenda® Tablets 5, 10 mg 60 ct. bottle
Namenda® Oral Solution 10 mg = 5 mL 360 mL bottle
Namenda® Titration Pak 5 & 10mg combination pack 28 x 5mg tablets
21 x 10mg tablets
Savella® Tablets 12.5, 25, 50, 100 mg 60 ct. bottle
Savella® Titration Pack 12.5, 25 & 50 mg combination pack 5 x 12.5mg tablets
8 x 25mg tablets
42 x 50mg tablets
Tiazac® Capsules 120, 180, 240, 300, 360, 420 mg 90 ct. bottle
Viibryd® Patient Starter Kit 10, 20, 40 mg combination pack 7 x 10mg tablets
7 x 20mg tablets
16 x 40mg tablets
Viibryd® Tablets 10, 20, 40 mg 30 ct. bottle
Device Size
AeroChamber-Plus® Flow-Vu* Small Mask,
Medium Mask
AeroChamber-Plus® Flow-Vu* Mouthpiece,
Large Mask

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

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

  ARMOUR®, BYSTOLIC®, CELEXA®, LEVOTHROID®, LEXAPRO®, SAVELLA®, VIIBRYD®
  are registered trademarks of Forest Laboratories, Inc.
  CAMPRAL® is a registered trademark of Merck Santé.
  DALIRESP® is a registered trademark of Nycomed GmbH.
  NAMENDA® is a registered trademark of Merz Pharma GmbH.
  TIAZAC® is a registered trademark of Valeant International Inc.


©2012 Forest Laboratories, Inc.  85-1021010 02/12

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