| Insurance Status |
Must be uninsured |
| Those with Part D Eligible? |
Yes |
| Income |
At or below 250% of FPL |
| Diagnosis/Medical Criteria |
FDA-approved diagnosis or authorized compendia listing |
| US Residency Required? |
Yes |
|
| Obtaining |
Health care provider must complete 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 |
|
| Amount/Supply
| Not specified |
| Sent To |
Doctor's office or specific site |
| Delivery Time |
Within 10 days |
| Refill Process |
New application |
| Limit |
Not specified |
| Re-application |
New application yearly |
|
