For the treatment of the signs and symptoms of Parkinson's disease (PD)
MIRAPEX ER

Thank you for choosing MIRAPEX ER Door-to-Door.

Patients can receive MIRAPEX ER for as little as $10 but no more than $30 for a one-month supply of brand-name MIRAPEX ER.

Please read the steps below to help you understand the MIRAPEX ER Door-to-Door registration process, online access, program pricing, and fulfillment requirements. There are 3 ways to obtain MIRAPEX ER for your patients through this program: fax, ePrescribing, or call to enroll your patient.

By fax:

  1. Complete the patient enrollment form provided to you by Boehringer Ingelheim and sign.*
  2. Fax the completed form to: 1-855-284-0572.
  3. The pharmacy will contact your patient for payment and delivery scheduling.
  4. Please note: Prescribing for this program is limited to a one-month supply only.
    The program cannot handle dose titration.

*If you need forms, click the button below.

Download Enrollment Form

By ePrescribing:

  1. In your ePrescribing system, use the "add provider" function to locate Eagle Pharmacy from the provider list, and follow the normal process for setup.
  2. If unsuccessful in Step 1, change the search from "name" to "provider number," and search for one of the following provider numbers:
    NCPDP: 5711975
  3. If you cannot locate Eagle Pharmacy as an option in your ePrescribing system, please contact your ePrescribing vendor.

By phone:

Call 1-855-900-0786 and provide the information from the completed enrollment form to the Eagle Pharmacy representative.

Indications:

Mirapex ER® (pramipexole dihydrochloride) extended-release tablets and Mirapex® (pramipexole dihydrochloride) tablets are indicated for the treatment of the signs and symptoms of idiopathic Parkinson's disease (PD).

Important Safety Information:

MIRAPEX ER and MIRAPEX may cause patients to fall asleep without warning signs during activities of daily living, including driving, which sometimes resulted in accidents. Some events may occur well after the start of treatment. Advise patients that, until they know how MIRAPEX ER or MIRAPEX affects them, or if they experience increased somnolence or episodes of falling asleep, they should not engage in potentially dangerous activities.

There have been reports of patients experiencing intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and the inability to control these urges while taking one or more of the medications that increase central dopaminergic tone and that are generally used for the treatment of PD, including MIRAPEX ER and MIRAPEX. Consider dose reduction or stopping MIRAPEX ER or MIRAPEX if a patient develops such urges.

As patients may not recognize or acknowledge increased drowsiness, sleepiness, or behavioral changes, prescribers should continually reassess patients.

Symptomatic orthostatic hypotension may occur, especially during initial treatment or dose escalation.
Hallucinations may occur at any time during treatment. MIRAPEX ER and MIRAPEX may potentiate the dopaminergic side effects of levodopa and may cause and/or exacerbate dyskinesia.

In a clinical trial for early PD, the most commonly reported adverse events with MIRAPEX ER that were more frequent than with placebo are somnolence, nausea, constipation, dizziness, fatigue, hallucinations, dry mouth, muscle spasms, and peripheral edema. In a clinical trial for advanced PD, the most commonly reported adverse events with MIRAPEX ER that were more frequent than with placebo are dyskinesia, nausea, constipation, hallucinations, headache, and anorexia.

In clinical trials for early PD, the most commonly reported adverse events with MIRAPEX that were more frequent than with placebo are nausea, dizziness, somnolence, insomnia, constipation, asthenia, and hallucinations.

In clinical trials for advanced PD, the most commonly reported adverse events with MIRAPEX that were more frequent than with placebo are postural (orthostatic) hypotension, dyskinesia, extrapyramidal syndrome, insomnia, dizziness, hallucinations, accidental injury, dream abnormalities, confusion, constipation, asthenia, somnolence, dystonia, gait abnormality, hypertonia, dry mouth, amnesia, and urinary frequency.

MIRAPEX ER is not recommended for patients with severe renal impairment (creatinine clearance [CrCl]<30 mL/min) or patients on hemodialysis. For patients with moderate renal impairment (CrCl between 30 and 50 mL/min), refer to full Prescribing Information for special dosing instructions. Patients with mild renal impairment (creatinine clearance [CrCl] >50 mL/min) require no reduction in daily dose.

MIRAPEX ER tablets are taken orally once daily and must not be chewed, crushed, or divided, and should be discontinued gradually over a period of one week.

Please see full Prescribing Information for MIRAPEX ER and MIRAPEX.

*Terms and Conditions: Patients must have a valid prescription for MIRAPEX ER. By enrolling, I elect to receive the branded product and acknowledge that no generic substitution will be offered (if applicable). Should I wish to receive a generic product in the future, I will call 1-855-900-0786 to opt out of this program.

Patients without insurance restrictions and co-pays of $115 or less will pay a $10 co-pay for a one-month supply of MIRAPEX ER. Patients whose co-pay is less than $10 will continue to pay their usual co-pay. For patients whose co-pay is between $115 and $135, they will pay that amount minus the maximum savings benefit of $105 per month. No one will pay more than $30. Patients with insurance restrictions or co-pays of more than $135 will not be processed through insurance and will pay $30 for a one-month supply (30 tablets) of MIRAPEX ER.

If you have Medicare Part D and 1) do not have insurance restrictions and 2) your co-pay is $30 or less, you will pay your co-pay amount for a one-month supply of MIRAPEX ER. If you have insurance restrictions or a co-pay of more than $30, your order will not be processed through insurance and you will pay $30 for a one-month supply (30 tablets) of MIRAPEX ER. Any Medicare Part D orders processed as cash cannot be applied to Part D true out of pocket (TrOOP) costs. Taxes may apply.

If you have Medicaid or a similar state or federally funded medical assistance program, you will pay a cash price of $30 for a one-month supply (30 tablets) of MIRAPEX ER. Taxes may apply.

Boehringer Ingelheim Pharmaceuticals, Inc. retains the right to rescind, revoke, or amend this offer at any time without notice.

This information is intended for US residents only.

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