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

AbbVie Patient Assistance Program Foundation for Lupron Depot

This program provides brand name medications at no or low cost

Provided by: AbbVie

PO Box 270
Somerville, NJ 08876

TEL: 800-222-6885


FAX: 866-483-1305
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

AbbVie Patient Assistance Foundation Application for Lupron Depot

 

Brand Name Medications Covered

 
  • Lupaneta Pack injection and tablet
  • Lupron Depot-PED injection
  • Lupron Depot injection
 

Generic Name

 
  • leuprolide acetate injection
  • leuprolide acetate/norethindrone acetate injection and tablet
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Considered on exception basis
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 2-3 days
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time 1-3 business days
Refill Process Patient or Doctor must contact company
Limit Not specified
Re-application New application yearly
   

Additional Information

Negative decision may be appealed.


Updated July 12, 2017