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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Abbott |
| Program Name |
Abbott Patient Assistance Foundation (Lupron Depot) |
| Program Address |
P.O. Box 270
Somerville, NJ 08876 |
| Phone Number |
800-222-6885
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| Fax Number |
866-483-1305 |
| Medications on Program |
Lupron Depot Injection 3.75mg, 7.5mg, 11.25mg, 15mg, 22.5mg, 30mg (leuprolide acetate for depot injection)
Lupron Depot PED Injection 7.5mg, 11.25mg, 15mg (leuprolide acetate for depot injection)
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| Application Forms |
Abbott Patient Assistance Foundation (Lupron Depot)
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On-line Application
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| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. US residency requirements are
not specified.
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| Application Process |
The doctor/doctor's office should call for an application. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
The doctor is notified of acceptance or denial. The medication is shipped out within 5-7 business days.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
The medication is sent to the doctor's office. The doctor/doctor's office must contact the company to arrange refills. Every year a new application is needed.
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| Last Updated |
May 11, 2010 |
