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Auxilium Patient Assistance Program
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40 Valley Stream Parkway
Malvem, PA 19355
Phone
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800-454-1467
Fax:
Not Applicable
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Eligibility
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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
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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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. |
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Supply
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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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This program is for male patients only. |
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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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| Testim 1% Gel |
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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 Application Form |
(Requires Acrobat Reader) 
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