Patient Assistance Program for Amevive

Astellas Pharma US I

Contact Information
10350 Ormsby Park Place
Suite 500
Louisville, KY 40218
1-(866) 263-8483 (phone)
1-(866) 250-2145 (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.
  • Click here to visit the program's web site.
  • Eligibility:
    The patient must have no insurance and meet income guidelines that are not disclosed. The patient must have a diagnosis of Chronic Plaque Psoriasis. The patient must live in the US at least six months out of the year. This program also does insurance verification and will help patients with insurance to appeal the insurance company to get the medication. If a patient has insurance, but was denied coverage, contact the company.
    Other Information:
    The doctor or patient can call to request an application. The enrollment form is faxed out. The completed application must be faxed or mailed from the doctor's office. The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income. Up to a 30-day supply is sent to the doctor's office. The company automatically sends out refills. Every 3 months a new application is needed.
    Product(s) covered by program:
    • Amevive Injection 15mg