Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||||||||||||
Astellas Pharma Support SolutionsThis program provides brand name medications at no or low cost |
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Provided by: Astellas Pharma, Inc. |
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PO Box 13185 TEL: 800-477-6472 |
Languages Spoken:
English |
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Patient Assistance Applications |
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Astellas Pharma Support Solutions Authorization Form |
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Brand Name Medications Covered |
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Generic Name |
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Eligibility Requirements |
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Insurance Status | Uninsured or Underinsured | |||||||||||||||
Those with Part D Eligible? | No | |||||||||||||||
Income | At or below 250% of FPL | |||||||||||||||
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 |
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Obtaining | Call, download or apply online | |||||||||||||||
Receiving | Downloaded from website | |||||||||||||||
Returning | Submitted online by health care provider | |||||||||||||||
Doctor's Action | Complete and submit an Astellas Access Program application via Astellas eService at www.astellasreimbursement.com | |||||||||||||||
Applicant's Action | Inform Doctor that he/she is in need | |||||||||||||||
Decision Communicated | Doctor notified | |||||||||||||||
Decision Timeframe | Not specified | |||||||||||||||
Medication |
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Amount/Supply | Not specified | |||||||||||||||
Sent To | Patient's home | |||||||||||||||
Delivery Time | Within 10 days | |||||||||||||||
Refill Process | Automatically sent out | |||||||||||||||
Limit | Not specified | |||||||||||||||
Re-application | New application yearly | |||||||||||||||
Additional Information |
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Please visit www.astellaspharmasupportsolutions.com for more information This program also provides copay assistance. |
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Updated February 12, 2018 |