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Astellas Patient Assistance Program for Organ Transplant
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PO Box 220708
Charlotte, NC 28222
Phone
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800-477-6472
Fax:
866-317-6235
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Eligibility
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The patient must meet income and insurance guidelines that are not disclosed. Patients with Medicare and Medicare Part D that are in the donut hole may qualify for assistance. |
| Who Can Apply
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This program will work with the patient and transplant team to complete the application process. The person who starts the process needs to have patient's diagnosis/transplant information, insurance information, health care provider information, and transplant doctor's name and phone number. |
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Required
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The doctor needs to sign the application and provide patient prescription information.The patient needs to sign the application and provide proof of income, expenses and asset information. |
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Supply
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Ship To
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Patient's home |
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Note
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This program will work with the patient and transplant team to complete the application process. The person who starts the process needs to have patient's diagnosis/transplant information, insurance information, health care provider information, and transplant doctor's name and phone number. |
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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.
| | Prograf (tacrolimus) |
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Patient Access Network Foundation (PAN)
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PO Box 221858
Charlotte, NC 28222
Phone
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(866)316-7263
Fax:
(866)316-7263
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Eligibility
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This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. |
| Who Can Apply
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Patients or healthcare providers can complete the application online or by phone. |
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Required
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Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received. |
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Supply
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Not applicable |
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Ship To
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Patient sent card to be used at pharmacy |
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Note
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*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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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.
| | Prograf (tacrolimus) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
| | Download printable Form | (Requires Acrobat Reader) 
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Prograf Patient Assistance Program
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Prograf Assistance Program
PO Box 221644
Chantilly, VA 20153-1644
Phone
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(800) 477-6472
Fax:
(703) 968-2909
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Eligibility
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The Prograf 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 physician. |
| Who Can Apply
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Physician's office must call on patient's behalf. |
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Required
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To enroll a patient, physicians must first register with the program. Registered physicians may enroll patients by submitting a patient enrollment form and a prescription. If approved, the patient will receive two 90-day shipments of Prograf â„¢ from a mailorder pharmacy affiliated with the program. The pharmacy will bill the patient $20 per shipment for expenses associated with dispensing and shipping the product.
A prescription for two three-month supplies of medication and completed application are required
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Supply
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6 month supply
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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 90-day shipments during the enrollment period. If continued therapy is needed beyond six months, the physician must resubmit the patient to the program.
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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.
| | Prograf (tacrolimus) |
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