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Patient Assistance Information

 
1 Program for Pentasa capsule; extended release
 
 
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.
 
Pentasa capsule; extended release
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
(Requires Acrobat Reader