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Patient Assistance Information

 
 
 
Astellas Stock Replacement Program For Mycamine

PO Box 221644
Chantilly, VA 20153-1644
Phone : 800-477-6472
Fax: 703-968-2909
Eligibility
> The patient must meet insurance and income guidelines that are not disclosed.
Who Can Apply
> The doctor, social worker, or physician office staff must call to pre-screen the patient for enrollment.
Required
> The doctor must fill out a section and sign the application.The patient must provide information (financial, insurance, and medical) but no signature is required.
Supply
> The product that was used will be replaced to the facility.
Ship To
> Doctor's office
Note
> The doctor, social worker, or physician office staff must call to pre-screen the patient for enrollment.
 
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.
 
Mycamine Injection