Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
2 Programs for Ultrase
 
 
Axcan ASSIST Program

PO Box 52065
Phoenix, AZ 85072-9152
Phone : 866-292-2679
Fax: Not Applicable
Eligibility
> 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
> Anyone can call to request an enrollment kit to be sent out.
Required
> The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Supply
> The patient is sent a pharmacy card to be used once a month.
Ship To
> Patient's home
Note
> There is a $2 co-pay at the pharmacy.
 
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
 
 
 
Comprehensive Care Program for CF

Comprehensive Care Program for CF
PO Box 52065
Phoenix, AZ 85072-9152
Phone : 866-292-2679
Fax: n/a
Eligibility
> 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
> The patient should call the Comprehensive Care for CFSM Program Line at (866) AXCAN-RX (866-292-2679) to enroll.
Required
> The doctor needs to provide a prescription to the patient.
Supply
> 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.
Ship To
> Patient will fill prescription at the pharmacy.
Note
> Anyone with the patient's and the doctor's information can call.
 
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