Namenda

Indicated For

Moderate to severe Alzheimer's disease dementia

About This Medication

# Allergan Patient Assistance Program: How to Get Namenda at Low or No Cost ## About This Program The Allergan Patient Assistance Program helps uninsured and underinsured patients in the United States access prescription medications at no cost when they cannot afford them. If you have been prescribed Namenda (memantine) for Alzheimer's disease or cognitive decline and are struggling with the cost, this program may be able to help you obtain your medication for free. ## Who Qualifies You may be eligible for the Allergan Patient Assistance Program if you meet these criteria: - You are a U.S. resident - You have a valid prescription for Namenda from a licensed physician - You are uninsured, underinsured, or unable to afford your medication's cost-sharing (copayments, coinsurance, or deductibles) - Your household income falls within the program's eligibility guidelines - You are not enrolled in Medicare Part D, or if you are, you have been denied the Low-Income Subsidy (LIS) ## Income Eligibility The program serves patients whose household income is at or below **200-400% of the Federal Poverty Level**. The exact threshold depends on your family size and current poverty guidelines. | Family Size | 200% FPL (2026) | 300% FPL (2026) | 400% FPL (2026) | |---|---|---|---| | Individual | ~$28,000 | ~$42,000 | ~$56,000 | | Couple | ~$37,000 | ~$55,500 | ~$74,000 | | Family of 3 | ~$46,500 | ~$69,750 | ~$93,000 | | Family of 4 | ~$56,000 | ~$84,000 | ~$112,000 | *Note: These are approximate figures based on 2026 federal poverty guidelines. Contact the program for exact current thresholds.* ## Insurance Requirements You are eligible if you: - Have no health insurance - Have health insurance that does not cover Namenda - Have insurance coverage but cannot afford your out-of-pocket costs (copayments, deductibles, or coinsurance) **Medicare Part D Enrollees:** If you are enrolled in Medicare Part D, you must first apply for and be denied the Low-Income Subsidy (LIS) through the Social Security Administration. You will need to submit your LIS denial letter with your application. ## How to Apply ### Step 1: Gather Required Documents Before starting your application, collect the following: - **Proof of household income:** Recent federal tax return (Form 1040, 1040A, 1040EZ, 1040NR, or 1040PR), Social Security/Disability award letter, recent pay stubs, or bank statements showing monthly direct deposits - **Proof of residency:** Utility bill, lease agreement, or other document showing your current address - **Valid prescription:** Your physician must write a prescription for a three-month supply of Namenda - **Insurance information:** Details about any current health insurance coverage (policy numbers, group numbers, copayment amounts) - **Medicare information (if applicable):** Your Medicare ID number and any LIS denial letter ### Step 2: Contact the Program Call the Allergan Patient Assistance Program at **(844) 424-6727** to request an application. You can also ask your prescribing physician's office to help you obtain and submit the application. ### Step 3: Complete the Application The application requires information from both you and your prescribing physician: - **Patient section:** Your personal information, household income details, insurance coverage, and financial situation - **Physician section:** Your doctor's signature, license information, and confirmation of medical need - **Signatures and authorization:** Your dated signature authorizing the program to process your application and receive your medication ### Step 4: Submit Your Application You have two options for submission: - **By mail:** Send your completed application with all required documents to: - Allergan Patient Assistance Program - PO Box 66764 - St. Louis, MO 63166 - **By fax:** Fax your application to **(844) 708-0036** (applications must be faxed from your physician's office with their fax banner attached) ### Step 5: Wait for Approval The program will review your application and notify both you and your physician about your eligibility status. ## Timeline and Medication Delivery **Processing Time:** Allow **2 to 6 weeks** for your application to be reviewed and processed. **Medication Supply:** Once approved, you will receive a **three-month supply** of Namenda. The medication will be shipped to your physician's office, where you can pick it up, or directly to your home address. **Refills:** You will receive a new three-month supply every three months during your 12-month enrollment period, as long as you remain eligible. ## Enrollment Period and Reauthorization Once approved, you are enrolled in the program for **12 months**. After this period ends, you must reapply to continue receiving assistance. When reapplying: - You will need new signatures from both you and your physician - You must provide a new prescription with current dates - You must submit updated proof of income - If information has not changed, you may not need to resubmit all documents, but confirm with the program ## What If Your Application Is Denied? If you are denied enrollment, the program will explain the reason. Common reasons include: - Income exceeding program limits - Incomplete application or missing documentation - Enrollment in Medicare Part D without an LIS denial letter - Insurance coverage that the program determines is adequate If denied, ask the program about: - Other patient assistance programs for Namenda - Generic memantine options that may be more affordable - State pharmaceutical assistance programs - Nonprofit organizations that help with medication costs - Manufacturer rebate programs or discount cards ## Important Restrictions While enrolled in the Allergan Patient Assistance Program: - You cannot purchase Namenda through your insurance plan - You cannot submit insurance claims for the medication - You cannot seek true out-of-pocket (TrOOP) credit for the medication - If you are a Medicare beneficiary, you must notify the program if your coverage status changes ## Questions? For more information or to apply, contact: **Allergan Patient Assistance Program** - Phone: (844) 424-6727 - Fax: (844) 708-0036 - Mailing Address: PO Box 66764, St. Louis, MO 63166 You can also ask your prescribing physician or pharmacist for assistance with the application process. ## Disclaimer This guide provides general information about the Allergan Patient Assistance Program based on publicly available program guidelines. Program eligibility, requirements, and benefits may change. For the most current and accurate information, contact the program directly at the phone number or address listed above. This guide is not a guarantee of eligibility or enrollment. Always consult with your healthcare provider about your medication needs and treatment options.

Program information last verified: March 30, 2026