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Patient Assistance Information

 
 
 
Astellas Patient Assistance Program for Vaprisol

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. This is a hospital replacement program, so the patient must have already received the medication. This program is only for patients who are hospital in-patients who are being treating for Euvolemic Hyponatremia.
Who Can Apply
> Someone from the hospital must call for an application. The application is sent to the hospital. 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 hospital contact person must fill out 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
>
Ship To
> The amount requested is sent to the hospital.
Note
>
 
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.
 
Vaprisol Injection