| Pharmaceutical Company | ICN Pharmaceuticals, Inc. |
| Program Address | ICN Pharmaceuticals, Inc. ICN Plaza 3300 Hyland Ave. Costa Mesa, CA 92626 |
| Toll Free Phone Number | 800-556-1937, option 4 |
| Alternate Phone Number | 714-545-0100 |
| Fax Number | 714-641-7289 |
| Guidelines and Notes | Call 8-5 Pacific time. They make Myasthenia Gravis drugs but there is a program for these drugs from the Myasthenia Gravis Association of Pennsylvania ( Mestinon, Prostigmin injectable, and prostigmin tablets) See separate entry. Though ICN purchased Limbitrol, Livrax and Levadromoran from Roche, these products are not available through their patient assistance program. |
| Initiating Enrollment | They willl send it to a healthcare professional. It can be copied. |
| Health Provider's Role | Completes, signs, and ATTACHES prescription written for am amount matching trade-size quantities. |
| Patient's Role | Sign form. |
| How Dispensed | Sends medicine to provider's office -- provide street address, NOT PO BOX!! |
| Amount Dispensed | Up to three trade-size bottles or tubes of medication per year. |
| Refills | They will only provide three months of medication per year unless prescriber writes a letter indicating that patient needs more than that.. |
| Limit | Three months per patient per year. |