Order Your Free Samples

Thank you for your interest in Nicomide®If you would like to receive samples, please fill out the sample request form below. You may also call 888.61. AVION (1.888.612.8466) to request free samples.

Samples are available to prescribers only. License numbers and addresses will be verified prior to shipping.
* Required

No More Than
$25 Per Fill*

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*Most eligible patients will pay no more than $25 for each fill. For Nicomide® the maximum benefit is $100 per fill. Patient will be responsible for any additional money due.

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