Patient Enrollment Form

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XTANDI Support SolutionsSM

Astellas has developed an integrated approach of customized access and reimbursement services to help you and your patients minimize potential barriers to accessing XTANDI. Eligibility rules may apply. Please contact XTANDI Support Solutions for more information.

XTANDI Support Solutions includes case management specialists and a network of specialty pharmacies all working together to ensure rapid patient access to XTANDI. XTANDI Support Solutions is available to providers, whether you dispense out of your office-based pharmacy or refer patients directly to a specialty pharmacy in the authorized XTANDI network. Support is available whenever you need it.


Submit Patient Enrollment Form to either XTANDI Support Solutions or a specialty pharmacy within our preferred network

XTANDI Support Solutions Specialists

Verify patient coverage for XTANDI

XTANDI Support Solutions

Assist with prior authorization tracking, if required

Address financial barriers for patients through the Astellas Access ProgramSM, the XTANDI Patient Savings ProgramSM, or referrals to independent not for profit copay foundations


Patients receive XTANDI from the specialty pharmacy or in-office pharmacy


Our goal is to help you and your patients access XTANDI. No matter how you decide to secure XTANDI for your patients, Astellas is here to support you.

XTANDI Support Solutions offers an array of resources to help facilitate product coverage and payment, and to ensure that your patients can access XTANDI. XTANDI Support Solutions can:

  • answer your questions about reimbursement, coverage, and payment for XTANDI;
  • verify patient insurance coverage and cost sharing for XTANDI;
  • help you and your staff verify insurance requirements and track prior authorizations;
  • provide assistance to you and your staff when prior authorizations are denied or when a patient's insurer does not cover XTANDI;
  • help you coordinate with a specialty pharmacy within our network that is contracted with your patients' insurers to dispense XTANDI;
  • determine whether your patients are eligible for patient or financial assistance for out-of-pocket costs associated with XTANDI;
  • provide you with 24/7 access to status updates on your requests for patient assistance via our eService at www.astellasaccess.com; and
  • direct your patients to additional information about XTANDI treatment with clinical and educational support via a team of nurses that are available 24 hours a day, 7 days a week.

XTANDI Support Solutions provides assistance with access-related issues throughout the entire treatment process, from the moment that you prescribe XTANDI until prescription fulfillment.

To enroll your patient in XTANDI Support Solutions, please complete the Patient Enrollment Form in its entirety (required fields marked with an asterisk), including the Signatures section, and return via fax to 1-855-982-6341. The completed Signature section allows XTANDI Support Solutions to do the following:

  • Perform the necessary service(s) to assist with patient access to XTANDI
  • Triage the completed prescription(s) to a specialty pharmacy in the XTANDI Support Solutions network
  • View patient's Personal Health Information, including a patient's financial information to determine the most appropriate form of financial assistance as appropriate