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Axcan ASSIST Program
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PO Box 52065
Phoenix, AZ 85072-9152
Phone
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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 |
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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.
|
| Ultrace MT Capsules |
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