Relpax

(eletriptan)
eletriptan 20 MG Oral Tablet [Relpax]eletriptan 40 MG Oral Tablet [Relpax]
NO BLACK BOX WARNING

Dosage & administration

Most viewed Relpax resources

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drug label

Relpax prescribing information

Have more Relpax questions?

Submit MSL Request
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Need to report a Relpax issue?

ONLINE FORM
Report adverse event
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samples

Request Relpax samples

NOT PROVIDED BY BRAND
View Online Sample Form
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prior authorization

Relpax Prior authorization resources

NOT PROVIDED BY BRAND
Complete Letter of Medical Necessity

NOT PROVIDED BY BRAND
Coverage Authorization Request

NOT PROVIDED BY BRAND
Coverage Authorization Appeals
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Benefits investigation

NOT PROVIDED BY BRAND
Benefits investigation resources
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Reimbursement help (FRM)

NOT PROVIDED BY BRAND
Reimbursement help (FRM) resources
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financial assistance

Relpax Financial assistance options

Co-pay savings program

commercial only
Enroll in Patient Savings Program
Activate Patient Savings Card ( if already have one)
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Bridge program

commercial only
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Foundation programs

under insured
no insurance
goverment insurance
65+
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patient education

Relpax Patient education

Getting started on Relpax

NOT PROVIDED BY BRAND
Instructions For Use - Acute Migraine Headaches

Patient toolkit

About Relpax
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
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Can't find what you're looking for?

Our trained staff can help you:
Please note:
  • Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
  • Samples are provided at the discretion of the brand.
  • We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.