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Patient Assistance Information

 
 
 
Axcan Rx Cost Reduction Program

PO Box 2914
Pheonix, AZ 85062
Phone : (800)482-2634
Fax:
Eligibility
> The Rx Cost Reduction Program is not available to patients who are participating in a federally-subsidized pharmacy benefit program, or where otherwise prohibited by federal or state law.
Who Can Apply
> Patient will complete a Rebate Claim Coupon (which you may obtain from any CF center or by calling 800-472-2634)
Required
> Completed Rebate Claim Coupon and the original pharmacy receipt.
Supply
> Patient will receive a check (up to $20) in about three weeks for the amount of your out-of-pocket expense. With the check will be another Rebate Claim Coupon for use the following month.
Ship To
> Patient's Home
Note
> You may submit only one Rebate Claim Coupon per month. The Rx Cost Reduction Program may not be combined with the CareFirst for CF or the Comprehensive Care Program for CF. Coupons must be fully completed to be processed.
 
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.
 
Ultrase MT 12 Capsules
Ultrase MT 18 Capsules
Ultrase MT 20 Capsules