For patients with no insurance and limited financial resources
To find out if you qualify for financial assistance from Cephalon, call the toll-free PROVIGIL Reimbursement Assistance Hotline at 1-800-675-8415.
You may qualify for financial assistance if you:
- Lack any form of medical insurance and are ineligible for third-party coverage
- Meet other requirements established for the PROVIGIL Assistance Program
The PROVIGIL Assistance Program is sponsored in full by Cephalon, Inc. and is solely administered by the National Organization for Rare Disorders (NORD), a not-for-profit organization dedicated to the identification, treatment, and cure of rare "orphan" diseases.
Cephalon reserves the right to modify or discontinue the program at any time.
PROVIGIL Reimbursement Assistance Consent Form
By completing this form, you authorize your prescribing physician and/or the PROVIGIL Reimbursement Hotline to release your confidential medical information for the purpose of conducting insurance research and/or assessing eligibility for the PROVIGIL Assistance Program.
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