| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Takeda Patient Support for LivtencityThis program provides brand name medications at no or low cost |
|||
Provided by: Takeda Pharmaceutical |
|||
TEL: 855-268-1825FAX: 855-268-1826 |
Languages Spoken:
English, Others By Translation Service |
||
Program Applications and Forms |
|||
Takeda Patient Support for Livtencity Patient Start Form |
|||
Takeda Patient Support for Livtencity Brochure |
|||
Medications |
|||
|
|||
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 | |||
