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

Ironwood Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Ironwood Pharmaceuticals, Inc.

2730 S Edmonds Lane
Suite 300
Lewisvile, TX 75067

TEL: 833-557-2413


FAX: 844-373-8785
Languages Spoken:

English Others By Translation Service

Program Website

 

Program Applications and Forms

Ironwood Patient Assistance Program Enrollment Form

 

Medications

  • allopurinol/lesinurad (Duzallo) 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Determined case by case
Income At or below 300% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
   

Medication

Amount/Supply Up to 30 Qty
Sent To Patient's home, unless otherwise noted
Delivery Time Within a week
Refill Process Patient must contact company
Limit None
Re-application Must re-enroll at end of calendar year
   

Additional Information


Updated November 07, 2017