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Patient Assistance Information

 
 
 
Astellas Patient Assistance Program for Protopic

PO Box 221644
Chantilly, VA 20153
Phone : (800) 477-6472
Fax: (703) 968-2909
Eligibility
> The patient must meet insurance and financial guidelines that are not disclosed. The patient must also be a US resident.
Who Can Apply
> The doctor, patient, social worker or patient advocate must call for a prescreening. The application is sent to the doctor's office. The completed application can be faxed back, but the originals must be mailed in as well. The decision is made during the phone screening.
Required
> The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies.
Supply
> A 6-month supply is sent to the doctor's office.
Ship To
> The medication is shipped within 10 business days.
Note
> Every year a new application is needed.
 
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)