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Patient Assistance Information

1 Program for Lupaneta Pack injection and tablet
AbbVie Patient Assistance Program for Lupron Depot

PO Box 270
Somerville, NJ 08876
Phone : (800)222-6885
Fax: (866)483-1305
> Must have no prescription coverage for needed medication. Medicare PartD patients considered on exception basis. Income requirements for this program have not been disclosed. Must be a US Resident.
Who Can Apply
> Call for application to be faxed, mailed, or download from website. Return application via fax or mail. Patient and Doctor are notified within 2-3 business days.
> Diagnosis/Medical Criteria not specified. Doctor must complete and sign application. Patient must complete application, sign and attach a copy of proof of income.
> Amount/Supply varies. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly.
Ship To
> Ships to Doctor's office within 1-3 business days.
> Negative decision may be appealed.
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.
Lupaneta Pack injection and tablet
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form AbbVie Patient Assistance Foundation for Lupron Depot
(Requires Acrobat Reader