Astellas Access ProgramSM for VESIcare

The Astellas Access ProgramSM for VESIcare is designed for patients who have no health insurance. This program provides free VESIcare to patients who qualify for enrollment based on insurance status and other criteria.

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

Program Explanation

You may be eligible the Astellas Access ServicesSM if you meet all of the following criteria:

Insurance Income Indication Residency
  • Are uninsured or awaiting determination from public assistance (such as Medicare).
  • 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 of less than or equal to 250% of the Federal Poverty Level. Please see chart below.
  • Proof of income is not required for enrollment but should be retained if requested. Please see list of acceptable forms of income documentation below.*
  • Have been prescribed VESIcare for an FDA-approved indication.
  • 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
2014 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 $11,670 $29,175 $14,580 $36,450 $13,420 $33,550
2 $15,730 $39,325 $19,660 $49,150 $18,090 $45,225
3 $19,790 $49,475 $24,740 $61,850 $22,760 $56,900
4 $23,850 $59,625 $29,820 $74,550 $27,430 $68,575
5 $27,910 $69,775 $34,900 $87,250 $32,100 $80,250
6 $31,970 $79,925 $39,980 $99,950 $36,770 $91,925
7 $36,030 $90,075 $45,060 $112,650 $41,440 $103,600
8 $40,090 $100,225 $50,140 $125,350 $46,110 $115,275
Each additional person $4060 $10,150 $5080 $12,700 $4670 $11,675

Source: Federal Register, Vol. 79, No. 14, Wednesday, January 22, 2014. Department of Health and Human Services. "Annual Update of the HHS Poverty Guidelines." Pages 3593-3594.

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 Astellas Access ServicesSM, we will notify both you and your healthcare provider that you have been enrolled. VESIcare will then be shipped directly to your home, including refills, so that you do not have to go to the pharmacy.

Enrollment for Astellas Access ServicesSM 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 Astellas Access ServicesSM at 1-800-477-6472.


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