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Patient Assistance Information

 
 
 
Auxilium Patient Assistance Program

40 Valley Stream Parkway
Malvem, PA 19355
Phone : 800-454-1467
Fax: Not Applicable
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below $18,000 per individual or $24,000 per couple. Patients who are eligible for Medicare Part D but chose not to enroll may be eligible for assistance.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> The doctor must fill out a section, sign the application and attach a prescription for 6 months. The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to a 90-day supply
Ship To
> Doctor's office
Note
> This program is for male patients only.
 
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.
 
Testim 1% Gel
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader