ELIGARD Reimbursement Hotline and Patient Assistance Program


The Eligard Hotline provides reimbursement services to all patients and a Patient Assistance Program which is designed to help the uninsured and people in need better afford their prescription medicines, subject to financial restrictions.
Contact Information
Eligard Reimbursement Hotline
PO Box 1074
San Bruno, CA 94066
1-(877) 354-4273 (phone)
1-(866) 354-4273 (fax)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Patient must be a legal resident of the United States. Patient's total annual household income must be below 250% of the Federal Poverty Line. Patient cannot have any government or private prescription coverage for these products. The Patient must be treated by a licensed physician and have a valid prescription for our product.
Other Information:
The Patient or physician's office should contact the Hotline to apply on behalf of a patient. An application is sent to the physician's office for completion and signature, in addition to a signed prescription. Upon receipt of completed application, prescription from physician, and approval of application, medication will be shipped directly to the physician's office from the distribution center. The patient is eligible for assistance for 6 months. If additional assistance is requested, a new application must be submitted to the hotline. In circumstances of significant financial need and serious medical hardship, individuals, with the help of their doctor, may appeal from denial of participation in this program.
Product(s) covered by program:
  • Eligard®