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

Astellas Pharma Support Solutions (AMBISOME)

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, Others By Translation Service

Program Website

 

Program Applications and Forms

Astellas Pharma Support Solutions (AMBISOME): Contact program

 

Medications

  • amphotericin B liposome injection (AmBisome) Injection
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Health care provider must complete online
Receiving Downloaded from website
Returning Submitted online by health care provider
Doctor's Action Enroll in the program
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Contact the program for more details.
Sent To Doctor's office
Delivery Time Not specified
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Please visit www.astellaspharmasupportsolutions.com for more information

Updated September 17, 2020