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

Access 360 (Fasenra)

This program provides brand name medications at no or low cost

Provided by: AstraZeneca Pharmaceuticals

Access 360
One Medimmune Way
Gaitherburg, MD 20878

TEL: 833-360-4357


FAX: 833-329-2360
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Access 360 (Fasenra) Enrollment Form

 

Brand Name Medications Covered

 
  • Fasenra
 

Generic Name

 
  • benralizumab
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income Varies. *See below for details
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or Puerto Rico
   

Application

Obtaining Call, download or apply online
Receiving Faxed or downloaded from website
Returning Fax or submit online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe 2-3 business days
   

Medication

Amount/Supply Contact the program for more details.
Sent To Doctor's office or specific site
Delivery Time Not specified
Refill Process Not specified
Limit Only limited by manufacturer's guidelines
Re-application Not specified
   

Additional Information

Access 360 can help identify patient-specific coverage for AstraZeneca medicines. The representatives can create an in-depth report identifying the patient's full coverage and out-of-pocket costs for medical, pharmacy, and home health benefits related to AstraZeneca products.

Free Trial Program: Contact Program for details www.FasenraSignUp.com


Updated December 05, 2017