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YOU&i Support Program
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Phone
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877-877-3536
Fax:
800-752-5896
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Eligibility
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Patients insurance status and income requirements will be considered on a case by case basis. Medicare Part D recipients are eligible. Patients must reside in the US. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded. |
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Required
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Patients must enroll online or by phone. Doctors must complete a section of the application and sign. The application can then be faxed or mailed. |
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Supply
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Varies |
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Ship To
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Patient's home |
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Note
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Call for detailed information on the other programs offered:
YOU&i Start Program: Eligible patients can receive up to a 30-day supply of Imbruvica free.
YOU&i Access Instant Savings Program: Eligible patients pay no more than $10 per month for Imbruvica. |
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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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| Imbruvica capsule |
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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 |
(Requires Acrobat Reader) 
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