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Patient Assistance Information

 
Program Sponsored By Pharmacyclics, LLC (External Link)
 
 
YOU&i Support Program


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Phone : 877-877-3536
Fax: 800-752-5896
Eligibility
> Patients insurance status and income requirements will be considered on a case by case basis. Medicare Part D recipients are eligible. Patients must reside in the US.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Patients must enroll online or by phone. Doctors must complete a section of the application and sign. The application can then be faxed or mailed.
Supply
> Varies
Ship To
> Patient's home
Note
> Call for detailed information on the other programs offered: YOU&i Start Program: Eligible patients can receive up to a 30-day supply of Imbruvica free. YOU&i Access Instant Savings Program: Eligible patients pay no more than $10 per month for Imbruvica.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Imbruvica capsule
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader