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Patient Assistance Information

 
 
 
Prograf Patient Assistance Program

Prograf Assistance Program
PO Box 221644
Chantilly, VA 20153-1644
Phone : (800) 477-6472
Fax: (703) 968-2909
Eligibility
> The Prograf Patient Assistance Program is designed to assist patients who have no health insurance and limited financial resources. To be eligible for the program, patients must meet income, residency and insurance criteria. If the patient meets the criteria, hotline staff will send a pre-filled application to the physician.
Who Can Apply
> Physician's office must call on patient's behalf.
Required
> To enroll a patient, physicians must first register with the program. Registered physicians may enroll patients by submitting a patient enrollment form and a prescription. If approved, the patient will receive two 90-day shipments of Prograf â„¢ from a mailorder pharmacy affiliated with the program. The pharmacy will bill the patient $20 per shipment for expenses associated with dispensing and shipping the product.

A prescription for two three-month supplies of medication and completed application are required

Supply
> 6 month supply
Ship To
> Patient's home
Note
> If approved, the patient will receive two 90-day shipments during the enrollment period. If continued therapy is needed beyond six months, the physician must resubmit the patient to the program.
 
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.
 
Prograf (tacrolimus)