Astellas Patient Assistance Program: Xospata

Funded

About

The Astellas Patient Assistance Program: Xospata offers a valuable opportunity for eligible patients to receive the drug Xospata at no cost. This program is designed to support patients who are uninsured or meet specific criteria, ensuring that they can access necessary medication without financial burden. The Astellas Patient Assistance Program: Xospata facilitates the process for both patients and healthcare providers with a straightforward enrollment procedure and timely medication delivery, fostering an accessible treatment pathway.

Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•This Program provides medicine to patients at no cost

•Patient’s healthcare provider must start the enrollment process by submitting the request form

•Once approved, patient and physician will be notified

•An initial 90day supply will be shipped to the patient within 25 business days, followed by subsequent 90day refills

•Program will notify patient 45 days before approval period is scheduled to end so provider can reapply

•Enrollment form can be faxed to 18447308816, uploaded to the Prescriber Portal (https://astellas.aspnprograms.com/Default.aspx), or completed electronically via the Prescriber Portal

Enrollment Forms

Enrollment Form