How to Apply

The Viatris Patient Assistance Program provides certain medicines for free to patients with a demonstrated financial need. To determine if you may be eligible, select your medicine from the menu below and follow the instructions shown on the application. If you have questions or need additional support, please call the customer service number listed below for your medicine.

Viatris Patient Assistance Program Medicines

Select your medicine from the drop down menu.

Viatris Patient Assistance Program Product Groups

For support, please contact the customer service number for your medicine.

 

Group 1 Medicines: Group 2 Medicines:
Phone: 888-417-5780 Phone: 888-417-5782
Fax: 877-427-7290 Fax: 866-792-7945

Group One Medicines
Arixtra® Gastrocrom®
Breyna® Miacalcin®
Clozapine® Perforomist®
Cortifoam® Pretomanid®
Cystagon® Proctofoam HC®
Denavir® Rowasa®
Dipentum® SF Rowasa®
Dymista® Wixela®
Emsam® Xulane®
Ermeza® Yupelri®
Felbatol®
Group Two Medicines
Caduet®
Epinephrine Injection
Glatiramer Acetate
Relpax®
Tobi® Products