About the program:
The Patient Assistance Program is designed to help qualified patients gain access to Procter & Gamble prescription medications free of charge. Through this program, qualified patients can receive a 90-day supply of their prescription and up to 3 refills.

All of Procter & Gamble's oral prescription medicines are available through the Patient Assistance Program:

Actonel® (risedronate sodium tablets)
Actonel® with Calcium (risedronate sodium tablets with calcium carbonate)
Asacol® (mesalamine delayed release tablets)
Dantrium® (dantrolene sodium capsules)
Didronel® (etidronate disodium tablets)
Macrobid® (nitrofurantoin monohydrate/macrocrystals capsules)
Macrodantin® (nitrofurantoin macrocrystals capsules)

Who is Qualified:

• A patient without affordable coverage for the Procter & Gamble medication, and
• With an annual income less than 200% of the federal poverty level, and
• Who is a U.S. resident.

To fairly determine an individual's qualification for the program, we require patients to submit: 1) a one page application form; 2) financial documentation as proof of their income, and 3) a signed prescription from their health care provider.

How to enroll:
For questions regarding this program or application, please call us at
1-800-830-9049.

To download the application form, click here:
PAP Application (PDF)
PAP Aplicacion (PDF, En Español)
Instructions are included in the download.

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Click here to download Adobe Acrobat.