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Patient Assistance Information

 
 
 
Amevive Start Assistance Program

10350 Ormsby Park Place
Suite 500
Louisville, KY 40218
Phone : 866-263-8483
Fax: (866)420-8888
Eligibility
> The patient must have no insurance and meet income guidelines that are not disclosed. The patient must have a diagnosis of Chronic Plaque Psoriasis.The patient must live in the US at least six months out of the year.
Who Can Apply
> The doctor or patient can call to request an application.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to a 30-day supply
Ship To
> Doctor's office
Note
> The doctor or patient can call to request an application.
 
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.
 
Amevive Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader