Request samples in a few easy steps.
Sign In or Check Eligibility
Enter your last name and NPI number.
Select Medication Samples & Savings Offers
Choose the samples you want.
Confirm Credentials & Sign
Print, sign, and fax the Sample Request Form; or simply sign with your finger on your mobile device.
Receive Samples
Medication samples typically arrive within 4 to 6 business days of your order.
Distribute Samples to Appropriate Patients
Patients appreciate that they can get started on their treatment right away at no cost.