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Shire Cares
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Shire Cares Patient Assistance & Support Program
PO Box 5666
Louisville, KY 40255
Phone
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888-227-3755
Fax:
877-922-7379
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Eligibility
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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
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Patients or healthcare providers can call to have an application faxed, mailed or it can be downloaded. |
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Required
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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. |
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Supply
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Not specified |
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Ship To
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Patient is sent a card to be used at the pharmacy. |
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Note
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Each Application will be considered on a case by case basis. |
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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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| Pentasa capsule; extended release |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
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