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

Takeda Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Takeda Pharmaceutical

PO Box 5727
Louisville, KY 40255-0727

TEL: 800-830-9159

FAX: 800-497-0928
Languages Spoken:

English, Others By Translation Service

Program Website


Patient Assistance Applications

Takeda Patient Assistance Program Application


Brand Name Medications Covered

  • Amitiza capsule
  • Oseni tablet
  • Colcrys tablet
  • Prevacid SoluTab tablet; delayed release
  • Dexilant capsule
  • Rozerem tablet
  • Kazano tablet
  • Trintellix tablet
  • Nesina tablet

Generic Name Medications Covered

  • alogliptin benzoate tablet
  • lansoprazole tablet; delayed release
  • alogliptin benzoate/pioglitazone tablet
  • lubiprostone capsule
  • alogliptin/metformin tablet
  • ramelteon tablet
  • colchicine tablet
  • vortioxetine tablet
  • dexlansoprazole capsule

Eligibility Requirements   

Insurance Status Must have no coverage for the requested medication, be ineligible for federal or state programs
Those with Part D Eligible? Yes
Income At or below 500% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes


Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription and include the DEA or state license number
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor notified of acceptance
Decision Timeframe 5-7 business days


Amount/Supply Up to 90 day supply
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application, new documentation yearly

Additional Information

Applicants not approved for enrollment in the program may have the opportunity to seek an exception to the program criteria.

Updated July 01, 2019