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

Takeda Patient Support for Livtencity

This program provides brand name medications at no or low cost

Provided by: Takeda Pharmaceutical


TEL: 855-268-1825


FAX: 855-268-1826
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Takeda Patient Support for Livtencity Patient Start Form

Takeda Patient Support for Livtencity Brochure

 

Medications

  • maribavir tablet (Livtencity) Tablet
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income Based on FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
   

Application

Obtaining Call, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax or submit online
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Co-payment assistance, patient support, and patient assistance programs are available for eligible patients.

Updated April 12, 2022