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

Access 360

Provided by: AstraZeneca Pharmaceuticals

Access 360
One Medimmune Way
Gaitherburg, MD 20878

TEL: 844-275-2360


FAX: 844-329-2360
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Access 360 Patient Authorization Form (PAF) Oncology

Access 360 Patient Authorization Form (PAF) Oncology (Spanish)

Access 360 Enrollment Form (Oncology)

 

Brand Name Medications Covered

 
  • Arimidex tablet
  • Iressa
  • Casodex tablet
  • Lynparza capsule
  • Faslodex injection
  • Synagis
  • FluMist Quadrivalent
  • Tagrisso tablet
  • Imfinzi
  • Zoladex implant
 

Generic Name

 
  • anastrozole tablet
  • goserelin acetate implant
  • bicalutamide tablet
  • influenza vaccine live
  • durvalumab
  • olaparib capsule
  • fulvestrant injection
  • osimertinib tablet
  • gefitinib
  • palivizumab
 

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 Not specified
US Residency Required? Yes, or have green card or work visa
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Varies
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
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.

Contact program for more details: www.myaccess360.com


Updated July 14, 2017