Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Astellas Pharma Support Solutions (XTANDI)

This program provides brand name medications at no or low cost

Provided by: Astellas Pharma, Inc.

PO Box 13185
La Jolla, CA 92039

TEL: 855-898-2634


FAX: 855-982-6341
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Astellas Pharma Support Solutions (XTANDI) Patient Enrollment Form

 

Brand Name Medications Covered

 
  • Xtandi
 

Generic Name

 
  • enzalutamide
 

Eligibility Requirements   

Insurance Status Must be uninsured or rendered uninsured
Those with Part D Eligible? Determined case by case
Income Gross family household income at or less than $125,000
Diagnosis/Medical Criteria FDA-approved diagnosis or authorized compendia listing
US Residency Required? Must have a verifiable US shipping address and be treated by US Doctor
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2 business days, once application process is complete
   

Medication

Amount/Supply Up to 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Within 3-5 business days
Refill Process Automatically sent out
Limit Varies
Re-application Company contacts patient about reapplying
   

Additional Information

Please visit www.astellaspharmasupportsolutions.com for more information

This program also provides copay assistance.


Updated August 16, 2017