Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Astellas Pharma Support Solutions

This program provides brand name medications at no or low cost

Provided by: Astellas Pharma, Inc.

PO Box 13185
La Jolla, CA 92039

TEL: 800-477-6472


Languages Spoken:

English

Program Website

 

Program Applications and Forms

Astellas Pharma Support Solutions Authorization Form

 

Medications

  • amphotericin B liposome injection (AmBisome) Injection
 

Eligibility Requirements   

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

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

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

Please visit www.astellaspharmasupportsolutions.com for more information

This program also provides copay assistance.


Updated August 16, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Astellas Stock Replacement Program

This program provides brand name medications at no or low cost

Provided by: Astellas Pharma, Inc.

PO Box 13185
La Jolla, CA 92039

TEL: 800-477-6472


FAX: 866-317-6235
Languages Spoken:

English Others By Translation Service

Program Website

 

Program Applications and Forms

Astellas Stock Replacement Program: Contact program

 

Medications

  • amphotericin B liposome injection (AmBisome) Injection
 

Eligibility Requirements   

Insurance Status Must be uninsured
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? Yes
   

Application

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
   

Medication

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
   

Additional Information

Please visit www.AstellasReimbursement.com for more information.


Updated August 16, 2017