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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:


Program Website


Patient Assistance Applications

Astellas Pharma Support Solutions Authorization Form


Brand Name Medications Covered

  • AmBisome injection
  • Myrbetriq tablet; extended release
  • Astagraf XL capsule; extended release
  • Prograf
  • Lexiscan solution; iv
  • VESIcare tablet
  • Mycamine injection

Generic Name

  • amphotericin B liposome injection
  • solifenacin tablet
  • micafungin sodium injection
  • tacrolimus
  • mirabegron tablet; extended release
  • tacrolimus capsule; extended release
  • regadenoson solution; iv

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
US Residency Required? Must have a verifiable US shipping address and be treated by US Doctor


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
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Not specified


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 for more information

This program also provides copay assistance.

Updated September 26, 2018