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Patient Assistance Information

 
 
 
Protopic Patient Assistance Program

Protopic Patient Assistance Program
PO Box 221644
Chantilly, VA 20153-1644
Phone : (800) 477-6472
Fax: (703) 968-2902
Eligibility
> The Protopic 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 patient or physician.
Who Can Apply
> Anyone may call to initiate the application process.
Required
> A prescription for two three-month supplies of medication and completed application are required.
Supply
> Patient will receive an initial shipment and one refill.
Ship To
> Patient's home.
Note
> If approved, the patient will receive two shipments during the enrollment period. If continued therapy is needed beyond 12 months, the patient must reapply 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.
 
Protopic (tacrolimus)