For patients who may not be able to afford their medication, the Mallinckrodt Patient Assistance Program offers assistance to those who qualify for a variety of products.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • A

    • Anafranil™ (clomipramine hydrochloride)
  • E

    • EXALGO® (hydromorphone HCI)
  • P

    • Pamelor™ (nortriptyline HCI)
  • R

    • Restoril™ (temazepam)
    • Roxicodone® (oxycodone hydrochloride)
  • T

    • Tofranil™ (imipramine hydrochloride)