| |
Shire Cares
|
Shire Cares Patient Assistance & Support Program
PO Box 5666
Louisville, KY 40255
Phone
:
888-227-3755
Fax:
877-922-7379
|
|
Eligibility
|
| > |
Patients insurance status will be considered on a case by case basis. Medicare Part D recipients are eligible. Patients must be at or below 300% of the Federal Poverty Level, must have an FDA-approved diagnosis and must be a US citizen or legal entrant. |
| Who Can Apply
|
| > |
Patients or healthcare providers can call to have an application faxed, mailed or it can be downloaded. |
|
Required
|
| > |
Doctors must complete a section of the application and sign. Patients must complete a section, sign, attach proof of income and attach any insurance information. |
|
Supply
|
| > |
Not specified |
|
Ship To
|
| > |
Patient is sent a card to be used at the pharmacy. |
|
Note
|
| > |
Each Application will be considered on a case by case basis. |
| |
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.
|
| Fosrenol |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
|
| |
|
|