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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company Astellas
Program Name Astellas Access Program (Amevive)
Program Address PO Box 13185
La Jolla, CA 92037
Phone Number

866-263-8483

Fax Number 866-420-8888
Medications on Program Amevive Injection 15mg (alefacept)
Application Forms Amevive Patient Assistance Program
On-line Application
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).

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.    

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.

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.

Last Updated June 04, 2010


                                         

Program 2 of 2.

This company does not offer a patient assistance program.
Pharmaceutical Company HealthWell Foundation
Program Name HealthWell Foundation Copay Program
Program Address P.O Box 4133
Gaithersburg, MD 20878
Phone Number

800-675-8416

Fax Number 800-282-7692
Medications on Program Amevive Injection 15mg (alefacept)
Application Forms Not Applicable
On-line Application
No on-line application available at this time
Web Site Click to go to program's web site
Eligibility Guidelines and Notes

Applicants with insurance are eligible. The Foundation considers an individual's financial, medical, and insurance situation when determining who is eligible for assistance. Families with incomes below 400% of the Federal Poverty Level may qualify. Cost of living in a particular city or state is also taken into account. Medication must be used for medically appropriate condition. The patient must also reside in the US. This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.

Application Process

Anyone can call to get the application sent out or it may be completed online. The application is sent out or it may be completed online.     

Application Requirements

Not applicable.

Program Details

Not applicable.

Last Updated April 28, 2010