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Patient Assistance Information

Program Sponsored By Shire US, Inc (External Link)
Shire Cares

P.O. Box 5666
Louisville, KY 40255
Phone : (888)227-3755
Fax: (877)922-7379
> The patient must meet insurance guidelines that are not disclosed and and have a household income of or less than 300% of FPL. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The type and level of assistance available varies based on the medication, the household income and the insurance status. Applications are reviewed on a case by case basis. Income guidelines provided are general guidelines.
Who Can Apply
> Anyone requesting assistance can call the above number to request an application be mailed or faxed out or download it from the website. The application can be either faxed or mailed out upon request. The completed application can be faxed or mailed back.
> The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Ship To
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.
Carbatrol Tablets
Daytrana Transdermal System
Intuniv Extended Release Tablets
Lialda Tablets
Pentasa Tablets
Vyvanse Capsules
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
(Requires Acrobat Reader