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Patient Assistance Information

 
 
 
Axcan ASSIST Program

PO Box 52065
Phoenix, AZ 85072-9152
Phone : 866-292-2679
Fax: Not Applicable
Eligibility
> The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident under the age of 65.
Who Can Apply
> Anyone can call to request an enrollment kit to be sent out.
Required
> The doctor needs to provide a prescription to the patient. The patient must fill out a section and sign the application.
Supply
> The patient is sent a pharmacy card to be used once a month.
Ship To
> Patient's home
Note
> There is a $2 co-pay at the pharmacy.
 
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.
 
Ultrace MT Capsules
Ultrase MT 20 Powder
Urso 250 Tablets
Viokase Tablets (amylase; lipase; protease)