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Axcan Rx Cost Reduction Program
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PO Box 2914
Pheonix, AZ 85062
Phone
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(800)482-2634
Fax:
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Eligibility
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The Rx Cost Reduction Program is not available to patients who are participating in a federally-subsidized pharmacy benefit program, or where otherwise prohibited by federal or state law. |
| Who Can Apply
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Patient will complete a Rebate Claim Coupon (which you may obtain from any CF center or by calling 800-472-2634) |
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Required
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Completed Rebate Claim Coupon and the original pharmacy receipt. |
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Supply
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Patient will receive a check (up to $20) in about three weeks for the amount of your out-of-pocket expense. With the check will be another Rebate Claim Coupon for use the following month. |
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Ship To
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Patient's Home |
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Note
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You may submit only one Rebate Claim Coupon per month. The Rx Cost Reduction Program may not be combined with the CareFirst for CF or the Comprehensive Care Program for CF. Coupons must be fully completed to be processed. |
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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.
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| Ultrase MT 12 Capsules |
| Ultrase MT 18 Capsules |
| Ultrase MT 20 Capsules |
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Care First for CF
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Care First for CF
PO Box 2914
Phoenix, AZ 85062
Phone
:
866-292-2679
Fax:
n/a
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Eligibility
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Any cystic fibrosis patient or Shwachman-Diamond Syndrome patient in the U.S. or Puerto Rico up to 3 years of age |
| Who Can Apply
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The caregiver should call (866) AXCAN-RX (866-292-2679) to enroll |
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Required
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The patient must provide information (financial, insurance, and medical) but no signature is required. |
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Supply
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The patient is sent a pharmacy card to be used once a month. |
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Ship To
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Patient's home |
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Note
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Patients will receive a free copy of Cystic Fibrosis: A Guide for Patient and Family educational book and a diaper bag with CareFirst for CF logo. |
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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.
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| ADEKs (mutivitamin, multimineral) |
| Ultrase EC Capsules |
| Ultrace MT 18 Capsules |
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Axcan ASSIST Program
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PO Box 52065
Phoenix, AZ 85072-9152
Phone
:
866-292-2679
Fax:
Not Applicable
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Eligibility
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The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident under the age of 65. |
| Who Can Apply
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Anyone can call to request an enrollment kit to be sent out. |
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Required
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The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application. |
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Supply
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The patient is sent a pharmacy card to be used once a month. |
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Ship To
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Patient's home |
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Note
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There is a $2 co-pay at the pharmacy. |
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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.
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| Ultrace MT Capsules |
| Ultrase MT 20 Powder |
| Urso 250 Tablets |
| Viokase Tablets (amylase; lipase; protease) |
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Comprehensive Care Program for CF
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Comprehensive Care Program for CF
PO Box 52065
Phoenix, AZ 85072-9152
Phone
:
866-292-2679
Fax:
n/a
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Eligibility
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Any cystic fibrosis patient or Shwachman-Diamond Syndrome patient in the U.S. or Puerto Rico who takes ULTRASE® or ULTRASE® MT |
| Who Can Apply
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The patient should call the Comprehensive Care for CFSM Program Line at (866) AXCAN-RX (866-292-2679) to enroll. |
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Required
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The doctor needs to provide a prescription to the patient. |
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Supply
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Patient will receive up to $20 for out-of-pocket expense for a prescription of ULTRASE® or ULTRASE® MT SCANDISHAKE® (24 envelopes) or SCANDICAL® (two 8-ounce canisters), ADEKs® Tablets (60-count) or Pediatric Drops (one 60mL bottle, a certificate for FLUTTER® mucus clearance device, redeemable with physician approval and Cystic Fibrosis: A Guide for Patient and Family educational book. |
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Ship To
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Patient will fill prescription at the pharmacy. |
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Note
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Anyone with the patient's and the doctor's information can call. |
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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.
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| ADEKs (mutivitamin, multimineral) |
| Adek Tablets |
| FLUTTER Mucus Clearance Device |
| Scandical |
| Scandishake |
| Ultrace MT Capsules |
| Ultrase MT (lipase; amylase; protease) |
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