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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Astellas |
| Program Name |
Astellas Access Program (Amevive) |
| Program Address |
PO Box 13185
La Jolla, CA 92037
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| Phone Number |
866-263-8483
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| Fax Number |
866-420-8888 |
| Medications on Program |
Amevive Injection 15mg (alefacept)
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| Application Forms |
Amevive Patient Assistance Program
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must be uninsured or underinsured and have an income at or below 300% of the Federal Poverty Level. The patient must have a diagnosis of Chronic Plaque Psoriasis or a diagnosis supported in Compendia. Patient must have a verifiable US address; US territories are included This program also does insurance verification and will help patients with insurance to appeal the insurance company to get the medication. If a patient has insurance, but was denied coverage, contact the company. When calling for the prescreening, have insurance, income , residency and diagnosis information available. When filling out the application the HCP should check all 3 boxes on the prescription section to request a full curse of therapy (12 weeks).
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| Application Process |
The patient or doctor needs to call for a prescreening. A pre-filled application is sent to the patient. The completed application can be faxed or mailed back.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
Up to a 30-day supply is sent to the doctor's office. The company contacts the doctor to arrange for refills. Every 6 months a new application is needed.
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| Last Updated |
November 13, 2009 |
