Dilantin

Indicated For

epilepsy, status epilepticus

About This Medication

# Viatris Patient Assistance Program Patient Guide: How to Get Dilantin (Phenytoin) at Low or No Cost ## About This Program The Viatris Patient Assistance Program (PAP) is a free medication program designed to help uninsured and underinsured patients access essential medications, including Dilantin (phenytoin), at no cost. Dilantin is an anticonvulsant medication used to prevent and control seizures. If you struggle to afford your prescription medications, this program may be able to help you receive your medication directly from Viatris at no charge. ## Who Qualifies for This Program To be eligible for the Viatris Patient Assistance Program, you must meet all of the following requirements[2][3]: - **U.S. Residency**: You must be a current United States resident (this includes U.S. Territories) - **Insurance Status**: You must be fully uninsured, or if you have insurance, you must have no prescription drug coverage - **Valid Prescription**: Your medication must be prescribed by a licensed U.S. healthcare professional for an FDA-approved indication - **Financial Need**: You must demonstrate financial need based on program criteria Each applicant is individually assessed for eligibility based on the information provided in the application[2][3]. ## Income Eligibility While specific income thresholds are not publicly detailed in available program materials, the program uses a needs-based assessment to determine eligibility. The program evaluates your individual financial situation as part of the application review process. When you apply, you will need to provide information about your household income and financial circumstances so the program can assess whether you qualify based on demonstrated financial need[2][3]. ## Insurance Requirements The program has specific insurance eligibility rules[2][3]: | Insurance Status | Eligible? | |---|---| | Fully uninsured | Yes | | Insured with prescription drug coverage | No | | Insured without prescription drug coverage | Yes | | Medicare Part D | Generally no, unless you meet specific criteria | If you have any form of prescription drug insurance, you typically will not qualify for this program. However, if you have health insurance but no prescription drug coverage, you may be eligible. Contact the program directly at 888-417-5780 to discuss your specific insurance situation[2][5]. ## How to Apply: Step-by-Step Instructions ### Step 1: Gather Required Information Before starting your application, have the following information ready[2][3]: - Your full name and date of birth - Your prescriber's name and NPI (National Provider Identifier) - Your prescription details (medication name, dosage, day supply, number of refills) - Your household income information - Proof of U.S. residency - Your insurance information (if applicable) ### Step 2: Complete the Application Form Obtain the Viatris Patient Assistance Program application form. The form is available as an interactive PDF that you can complete on your computer[7]. Ensure you complete all sections of the form in full, including all required signatures[2][3]. ### Step 3: Get Your Prescription Certified Your healthcare provider must complete the prescriber certification section of the application and sign and date it. The prescription must be for an FDA-approved indication[2][3]. ### Step 4: Submit Your Application Once completed and signed, submit your application using one of these methods[2][3][5]: - **Fax**: 877-427-7290 - **Email**: ViatrisPAP@viatris.com - **Phone**: 888-417-5780 (Monday-Friday, 8 AM to 5 PM EST) ## Application Timeline and Medication Delivery Here's what to expect after you submit your application[4]: - **Within 5 business days**: Viatris will notify you if they need additional information to process your application - **Within 3 business days of providing requested information**: You will receive notification of your eligibility determination - **If approved, within 10 business days**: You and your healthcare provider will receive an enrollment letter - **Within 5-7 business days of enrollment**: Your medication will be sent directly to your pharmacy or healthcare provider ## Program Benefits and Duration If you are approved for the program[2][3]: - You will receive your Dilantin at no cost - Your enrollment period is 12 months - You can receive a maximum of 11 refills per enrollment period for each unique medication - Your eligibility can be renewed upon reapplication and redetermination ## What If Your Application Is Denied? If your application is denied, you have several options: 1. **Contact the program**: Call 888-417-5780 to understand why you were denied and whether you can reapply with additional information 2. **Explore other assistance programs**: Other pharmaceutical companies and nonprofit organizations offer patient assistance programs 3. **Discuss with your healthcare provider**: Your doctor may know of other resources or lower-cost alternatives 4. **Look into generic options**: Generic phenytoin may be available at lower cost through retail pharmacies or other assistance programs 5. **Check for state programs**: Some states offer pharmaceutical assistance programs for residents ## Important Reminders - The application must be complete and signed to be reviewed for eligibility[2][3] - Each applicant is individually assessed based on their specific circumstances - Your eligibility is renewable, meaning you can reapply after your 12-month enrollment period ends - Contact customer service at 888-417-5780 if you have questions at any point in the process ## Disclaimer This guide provides general information about the Viatris Patient Assistance Program based on publicly available program materials. Program details, eligibility requirements, and benefits may change. For the most current and accurate information, contact Viatris Patient Assistance Program directly at 888-417-5780 (Monday-Friday, 8 AM to 5 PM EST) or visit the official Viatris website. This guide is not a guarantee of program eligibility or approval. Always consult with your healthcare provider about your medication needs and treatment options.

Program information last verified: March 30, 2026