Drug Information
Drug	Arimidex 1mg
Generic Equivalent	anastrazole
Topic	Cancer
Program Contact Info / Application Submission
Program	AstraZeneca Foundation Patient Assistance Program (Arimidex & Casodex)
Company	AstraZeneca
Form	Download PDF
Address	PO Box 66551, St Louis, MO 63166-6551
Phone	1-800-424-3727
Website	http://www.astrazeneca-us.com/content/drugAssistance/
Program Details
Details	A 90-day supply is sent to either the doctor�s office, hospital or pharmacy. Patients or doctors must contact the company for refills. A new application with documentation is needed once a year.
Program Requirements
Information	All signatures must be original, and proof of income must include tax forms as well as current proof.
Details	Insurance card NOT required Drivers license required Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero income required as proof of income Form 4506T (If taxes were not filed) NOT required as proof of income Most recent bank statements NOT required as proof of income Most recent check/check stub copy NOT required as proof of income Letter from employer required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement NOT required as proof of income Award Letter for Alimony/Child Support, Unemployment NOT required as proof of income Notarized statement from patient stating zero income required as proof of income
Delivery of Medication
Delivery Options	Can be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
App Process	The doctor must attach a 90-day prescription to all applications.
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can apply for a new application via phone Can apply for a new application via fax Can NOT apply for a new application via mail
Refills	Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can NOT apply for refills via phone Can apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can Re-Apply via phone Can Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can apply for an appeal via phone Can apply via fax Can NOT apply for an appeal via mail
Eligibility
Eligibility	Patiens must not have prescription coverage and be ineligible for any state or federal programs such as Medicaid. The income requirements are based on 300% of the federal poverty level.
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are NOT eligible if the medication is not covered under Medicare Patients are NOT eligible if Medicare coverage has been exhausted
Appeals
Conditions	Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied
Other Medications
Other  Medications  available in  this program	Arimidex 1mg - Cancer (Generic: anastrazole) Casodex 50mg - Cancer (Generic: bicalutamide)