Phone-in or written applications are acceptable for program enrollment. The physician's office must apply on behalf of a patient. Upon receipt and approval of a completed application, a three-month supply of medication will be shipped to the physician's office on the patient's behalf in approximately two weeks. If the patient is not covered for outpatient prescription drugs under private insurance or a public program, the patient's income must fall below the level selected by the company. If the patient has insurance coverage for outpatient prescription drugs, he or she may be eligible for assistance with deductibles or maximum benefit limits.
Eligibility is determined by the company based on income information provided by the physician.
Other Program Information Referral must be made by the physician. Income eligibility is based upon multiples of the U.S. poverty level adjusted for household size. Other Program Information Reapplication is required every 12 months. A reapplication is automatically sent to enrolled patients. Physicians also can obtain a packet of applications from their AstraZeneca sales representative.