Order MuGard® Oral Mucoadhesive in 2 steps

Complete and sign the prescription order form available online or from your MuGard representative.

The completed prescription order form should be faxed to 877-591-2505 or 216-591-2505.

AMAG Assist Patient Reimbursement and Support Center (AMAG Assist™) works with retail, mail-order, and specialty pharmacies in the United States to determine the patient’s best option for delivery.

To download detailed instructions for obtaining MuGard, please click here.

It’s important to remember that:

  • One bottle of MuGard lasts about one week
  • When completing the prescription order form, indicate the initial quantity to be dispensed
  • Please complete the entire form, and be sure you and your patient both sign and date the form. Note that accompanying forms can be provided in lieu of certain fields on the prescription order form (ie, the patient bio sheet) as long as all information is provided
  • Patients may be contacted by AMAG Assist if additional information is required
  • Additional refills may be required depending on the patient’s cancer regimen and length of treatment
  • For more information, contact AMAG Assist toll-free at 1-844-635-AMAG (2624)