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Astellas Patient Assistance Program for Protopic
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PO Box 221644
Chantilly, VA 20153
Phone
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(800) 477-6472
Fax:
(703) 968-2909
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Eligibility
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The patient must meet insurance and financial guidelines that are not disclosed. The patient must also be a US resident. |
| Who Can Apply
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The doctor, patient, social worker or patient advocate must call for a prescreening. The application is sent to the doctor's office. The completed application can be faxed back, but the originals must be mailed in as well. The decision is made during the phone screening. |
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Required
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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 denial letters from insurance companies.
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Supply
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A 6-month supply is sent to the doctor's office. |
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Ship To
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The medication is shipped within 10 business days. |
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Note
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Every year a new application is needed. |
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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.
| | Protopic (tacrolimus) |
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Protopic Patient Assistance Program
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Protopic Patient Assistance Program
PO Box 221644
Chantilly, VA 20153-1644
Phone
:
(800) 477-6472
Fax:
(703) 968-2902
|
|
Eligibility
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The Protopic Patient Assistance Program is designed to assist patients who have no health insurance and limited financial resources. To be eligible for the program, patients must meet income, residency, and insurance criteria. If the patient meets the criteria, hotline staff will send a pre-filled application to the patient or physician. |
| Who Can Apply
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Anyone may call to initiate the application process. |
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Required
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A prescription for two three-month supplies of medication and completed application are required. |
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Supply
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Patient will receive an initial shipment and one refill. |
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Ship To
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Patient's home. |
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Note
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If approved, the patient will receive two shipments during the enrollment period. If continued therapy is needed beyond 12 months, the patient must reapply to the program. |
| |
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.
| | Protopic (tacrolimus) |
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