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AbbVie Patient Assistance Program for Lupron Depot
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PO Box 270
Somerville, NJ 08876
Phone
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(800)222-6885
Fax:
(866)483-1305
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Eligibility
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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
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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. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor must complete and sign application. Patient must complete application, sign and attach a copy of proof of income. |
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Supply
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Amount/Supply varies. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Ships to Doctor's office within 1-3 business days. |
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Note
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Negative decision may be appealed. |
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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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| Lupron Depot-PED injection |
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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 AbbVie Patient Assistance Foundation for Lupron Depot |
(Requires Acrobat Reader) 
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