Astellas Access ProgramSM for Prograf

The Astellas Access ProgramSM (AAP) for Prograf is designed for patients who are uninsured. This program provides free Prograf to patients who qualify for enrollment based on insurance status and other criteria.

Astellas Access ServicesSM (AAS) can quickly determine whether you are eligible for enrollment.

Program Explanation

You may be eligible for the AAP if you meet all of the following criteria:

Insurance Income Indication Residency
  • Must be uninsured.
  • If you have any form of insurance (eg, commercial, Medicare, Medicaid, VA/ DoD), you are not eligible for this program.
  • Have a total household income within our guidelines. Please see chart below.
  • Patients must provide proof of income when applying to the AAP for Prograf. Please see list of acceptable forms of income documentation below.*
  • Must receive a Prograf prescription for its labeled indication.
  • Program excludes all patients who have received a kidney-only transplantation.
  • Must have a verifiable shipping address within the United States.

*Acceptable forms of income documentation include:

  • Latest federal or state tax return
  • Latest W-2 statement
  • SSDI/SSI award letter
  • Latest bank statement (one month)
  • Latest pay stub(s) (one month)
  • State program acceptance letter or card
  • 1099 Social Security form

 

2013 HHS Poverty Guidelines

The AAP uses the Federal Poverty Level (FPL) as the basis for assessing financial eligibility for patient assistance. The FPL establishes an income threshold for poverty based on the number of people in a household and is updated every year by the Department of Health and Human Services. Patient income must be less than or equal to 2.5x the FPL to qualify for assistance for an Astellas product. The table below outlines the 2013 FPL for the continental United States, Alaska, and Hawaii, and the AAP financial criteria (2.5x the FPL).

2013 Federal Poverty Level Guidelines
Household Size Continental United States Alaska Hawaii
FPL 2.5x the FPL FPL 2.5x the FPL FPL 2.5x the FPL
1 $11,490 $28,725 $14,350 $35,875 $13,230 $33,075
2 $15,510 $38,775 $19,380 $48,450 $17,850 $44,625
3 $19,530 $48,825 $24,410 $61,025 $22,470 $56,175
4 $23,550 $58,875 $29,440 $73,600 $27,090 $67,725
5 $27,570 $68,925 $34,470 $86,175 $31,710 $79,275
6 $31,590 $78,975 $39,500 $98,750 $36,330 $90,825
7 $35,610 $89,025 $44,530 $111,325 $40,950 $102,375
8 $39,630 $99,075 $49,560 $123,900 $45,570 $113,925
Each additional person $4,020 $10,050 $5,030 $12,575 $4,620 $11,550

If you meet these criteria, your healthcare provider must start the enrollment process by submitting the patient enrollment form that includes the necessary information to assess your eligibility.

Once you are approved for the AAP, we will notify both you and your healthcare provider that you have been enrolled. Prograf will then be shipped directly to your home, including refills, so that you do not have to go to the pharmacy.

Enrollment for the AAP may last up to one year. After this initial time, you may be eligible to re-enroll in the program.

To learn more about this program and how it works, please contact your doctor’s office or call AAS at 1-800-477-6472.


PLEASE SEE INDICATION AND IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING HERE.
PLEASE SEE FULL PRESCRIBING INFORMATION HERE.

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