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Patient Assistance Program (PAP) Application
o Apriso® (mesalamine) Extended-release Capsules .375 g o Colazal® (balsalazide disodium) Capsules 750 mg o Cycloset® (bromocriptine mesylate tablets) 0.8 mg o ® Fulyzaq (crofelemer) 125 mg Delayed-Release Tablets o ® Giazo (balsalazide disodium) Tablets 1.1 g oelistorR ® (methylnaltrexone bromide) Subcutaneous Injection 12 mg/0.6 mL
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