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Patient Assistance Information

 
 
 
AbbVie Patient Assistance Program for Lupron Depot

PO Box 270
Somerville, NJ 08876
Phone : (800)222-6885
Fax: (866)483-1305
Eligibility
> Must have no prescription coverage for needed medication. Medicare PartD patients considered on exception basis. Income requirements for this program have not been disclosed. Must be a US Resident.
Who Can Apply
> Call for application to be faxed, mailed, or download from website. Return application via fax or mail. Patient and Doctor are notified within 2-3 business days.
Required
> Diagnosis/Medical Criteria not specified. Doctor must complete and sign application. Patient must complete application, sign and attach a copy of proof of income.
Supply
> Amount/Supply varies. Patient or Doctor must contact company for refills. Refill limit not specified. New application must be completed yearly.
Ship To
> Ships to Doctor's office within 1-3 business days.
Note
> Negative decision may be appealed.
 
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.
 
Lupaneta Pack injection and tablet
Lupron Depot injection
Lupron Depot-PED injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form AbbVie Patient Assistance Foundation for Lupron Depot
(Requires Acrobat Reader