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Auxilium Patient Assistance Program
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40 Valley Stream Parkway
Malvem, PA 19355
Phone
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800-454-1467
Fax:
Not Applicable
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Eligibility
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The patient must have no prescription coverage for the requested medication and have an income at or below $18,000 per individual or $24,000 per couple. Patients who are eligible for Medicare Part D but chose not to enroll may be eligible for assistance. |
Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
Required
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The doctor must fill out a section, sign the application and attach a prescription for 6 months. The patient must fill out a section, sign the application and attach proof of income. |
Supply
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Up to a 90-day supply |
Ship To
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Doctor's office |
Note
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This program is for male patients only. |
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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. |
Testim 1% Gel |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form Application Form |
(Requires Acrobat Reader)
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